Medicare Risk Adjustment Strategy Program Manager

The Medicare Risk Adjustment Strategy Program Manager will report to the Senior Director of Medicare Risk Adjustment and Analytics. This role will manage the process of developing and maintaining the risk adjustment strategic plan. This position will track and monitor the key performance indicators of multi-year strategies and tactics designed to ensure complete and accurate medical record documentation and coding. The Program Manager will contribute to the development of strategies and facilitate discussion across multiple business areas. The role will engage with key stakeholders, communicate program results, and represent and advocate for the Risk Adjustment Team's business interests in corporate and cross-functional projects. This position will work with cross-functional teams to analyze and present key financial and strategic issues to senior leadership. The ideal candidate will possess excellent verbal/communications skills and have a thoughtful, persuasive personal style.

Your Day to Day:

• Manage the creation of and maintain a multi-year business plan for risk adjustment
• Evaluate risk adjustment policy positions to determine impact to BCBSMA and suggest policy direction to benefit BCBSMA performance
• Analyze, research and communicate business implications of and recommendations for action based on federal legislative and regulatory changes, market dynamic forces, and new competitive threats around Medicare revenue and risk adjustment
• Assess new proposals or regulatory positions to identify risks, gaps, impacts and advise modifications
• Maintain key relationships throughout the organization including, but not limited to, Medicare Product, Provider Contracting, Health and Medical Management, Actuarial, and Finance
• Actively manage the facilitation of the Risk Revenue Steering Committee, setting agenda topics, development of materials, and coordinating discussions
• Individually and in collaboration with other areas, develop and monitor key performance indicators on risk adjustment performance that will assess the progress of the risk adjustment strategy
• Develop and maintain a document to track and report on key strategic initiatives and opportunities through various stages of development and approval
• Participate in cross functional work to assess new strategic initiatives and determine financial viability
• Track and monitor key financial assumptions related to risk adjustment
• Develop documentation of strategic considerations and recommendations

We're Looking for:

• Excellent knowledge of Medicare Advantage risk adjustment programs and industry trends
• Knowledge of provider contracting, product development, operations, financing and revenue generating programs
• Knowledge of Medicare Part D program, operations and industry trends
• Proven ability to work collaboratively with leaders to align and execute on a strategic plan
• Ability to work independently, confidently, and respectfully
• Demonstrated ability to own problems and independently and recommend solutions
• Excellent written and oral communication and interpersonal skills
• Ability to collaborate in cross-functional business environment and to work closely with internal and external business partners
• Strong ability to multi-task and manage multiple deliverables while demonstrating high quality of work and meeting agreed upon deadlines
• Excellent time management and organizational skills
• Demonstrated data-driven decision-making skills

What You Bring:

• Bachelor's Degree or equivalent work experience.
• 6-8 years of relevant experience, preferably in health insurance
• Medicare Advantage and Prescription Drug Plan experience a plus

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High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.