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Blue Cross and Blue Shield of Minnesota · 2 months ago

Director Risk Adjustment and Quality Analytics - Actuarial

Eagan, MN

Full-time

Hybrid

Mid, Senior Level

$136K/yr - $230K/yr

7+ years exp

Blue Cross and Blue Shield of Minnesota is committed to transforming healthcare and improving member health. They are seeking a Director of Risk Adjustment and Quality Analytics to lead a team focused on risk adjustment and quality programs, ensuring accurate management of member health and risk. The role involves overseeing analytics, operational metrics, and team leadership to drive performance improvements and strategic initiatives.

Insurance

Comp. & Benefits

Responsibilities

Performs risk score computation and forecasting for Medicare, ACA, and Medicaid

Oversees diagnostic coding gap identification (suspecting), confidence modeling, and benchmarking

Responsible for operational metric tracking and performance improvement opportunity identification

Involved with the targeting and evaluation of in-home assessment, chart review, and point of care programs

Calculates the financial impact of various improvement opportunities and provides guidance for pricing and budget

Develops and monitors risk score trends to support bid development and financial forecasting

Tracks and evaluates risk adjustment initiatives performance across Medicare, ACA, and Medicaid throughout the year

Identifies and escalates potential data leakage issues for operational teams to address

Drives the design, development, and maintenance of dashboards to monitor risk adjustment initiatives and outcomes

Collaborates with provider engagement teams to track and report provider performance metrics

Provides audit support for RADV, OIG, and other regulatory or internal audits

Provides strong leadership to the Quality and Risk Adjustment Analytics team, including building a successful team, developing strategic partnerships, and influencing across Blue Cross highly matrixed organizational structure to represent enterprise risk adjustment and quality interests

Stays abreast of changes in the rapidly evolving health care marketplace and understands how trends, competitors, external context, and internal dynamics shape opportunities and challenges for the business

Effectively communicates complex concepts, strategies, initiatives, analytics, and results to a variety of stakeholders, including senior staff and executive leadership

Understands the strategy and future direction of Blue Cross, as well as challenges and opportunities that are inherent to that strategy and direction

Ensure that the priorities of the team reflect the company’s strategic direction, and ensure the teams knowledge, skills, and ability are adequate to meet current and evolving needs of the Risk Adjustment and Quality programs

Directs the team, including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training

Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations, and cost control

Qualification

Statistical modelingData analysisLeadershipSASHealthcare industry knowledgeCommunication skillsProblem-solvingCollaborationStrategic thinkingFlexibility

Required

Accepting this position at BCBSMN requires signing an Employee Confidentiality, Intellectual Property Assignment and Restrictive Covenants Agreement as a condition of employment

7+ years of related professional experience, with 3+ years of management experience. All relevant experience including work, education, transferable skills, and military experience will be considered

ASA or equivalent experience

Demonstrated ability to evaluate quantitative data from multiple sources using statistical modeling, analytical methods, and critical thinking skills

Proficient with methods and tools to perform statistical analysis, performance measurement, and cost analysis

Proficient with statistical software suites (e.g. SAS, cloud-based platforms), strong understanding of database structure, relational database concepts and data architecture

Ability to define problems, collect data, establish facts, and draw valid conclusions

Strong problem-solving skills exhibited by the ability to approach complex, ambiguous business issues with creative ideas and solutions

Superior executive level communication, facilitation, and presentation skills

Proven ability to establish trust and build collaborative relationships with key constituents (internal leaders and experts across the organization)

Ability to navigate ambiguity in a complex, matrixed environment

Must be a strategic thinker, with a high level of intellectual curiosity and openness to change

Proven ability to perform complex business analysis and decision-making, with the ability to effectively analyze and synthesize large amounts of complex data in relevant insights

Demonstrated experience in collaboration, teamwork, and cross-functional communication

Demonstrated ability to communicate across a large, complex health care organizations and deliver persuasive messages based on thorough fact-based analysis

Effective, concise, and professional written, verbal and presentation skills

Knowledge of healthcare industry including familiarity with health benefit plans and product features, provider contracting approaches, reimbursement approaches and health management approaches

Flexible, self-motivated, and continuously seeking ways to improve

Demonstrated leadership ability exemplified by a capacity to think strategically and implement tactically to consistently deliver results; well-developed skills in diplomacy and collaboration; and ability to develop and lead high performance and collaborative teams

High school diploma (or equivalency) and legal authorization to work in the U.S

Preferred

FSA or masters degree in health services research or statistics or related area

Senior leadership experience in a health care company

Business intelligence experience

Benefits

Medical, dental, and vision insurance

Life insurance

401k

Paid Time Off (PTO)

Volunteer Paid Time Off (VPTO)

And more

Company

Blue Cross and Blue Shield of Minnesota

Glassdoor4.0

About Blue Cross Blue Cross and Blue Shield of Minnesota is a taxable, nonprofit organization with a mission to make a healthy difference in people’s lives.

Founded in 1933

Eagan, Minnesota, USA

1001-5000 employees