Director Risk Adjustment AnalyticsBlue Cross & Blue Shield of Minnesota • United States
Director Risk Adjustment Analytics
Blue Cross & Blue Shield of Minnesota
- United States
- United States
Über
Blue Cross and Blue Shield of Minnesota is committed to helping everyone achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. Join a culture built on values of succeeding together, finding a better way, and doing the right thing. The Impact You Will Have
The Director of Risk Adjustment Analytics leads a team that delivers insights and results in support of the Risk Adjustment program. This leadership role enables improved accuracy in understanding the illness burden of our membership to better manage risk, care, and health. Your 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 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 Risk Adjustment Analytics team, including building a successful team, developing strategic partnerships, and influencing across a highly matrixed organization to represent enterprise risk adjustment interests.
Stays abreast of changes in the rapidly evolving healthcare marketplace and understands how trends 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, and the challenges and opportunities inherent to that strategy.
Ensures team priorities reflect the company’s strategic direction and that the team has the knowledge, skills, and ability to meet current and evolving needs of the Risk Adjustment programs.
Directs the team, including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive proper training.
Conducts performance evaluations and is responsible for managing employees, including skill and career development, policy administration, coaching on performance and behavior, employee relations, and cost control.
Required Skills and Experience 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.
Ability to evaluate quantitative data from multiple sources using statistical modeling, analytical methods, and critical thinking.
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 and ability to address 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 across the organization.
Ability to navigate ambiguity in a complex, matrixed environment.
Strategic thinker with high intellectual curiosity and openness to change.
Proven ability to perform complex business analysis and decision-making with large data insights.
Demonstrated experience in collaboration, teamwork, and cross-functional communication.
Ability to communicate across a large, complex health care organization and deliver persuasive messages based on fact-based analysis.
Effective, concise, and professional written, verbal and presentation skills.
Knowledge of healthcare industry including familiarity with health benefit plans, provider contracting approaches, reimbursement approaches, and health management approaches.
Flexible, self-motivated, and continuously seeking ways to improve.
Demonstrated leadership ability with strategic thinking and tactical implementation to deliver results; diplomacy and collaboration; and the ability to develop and lead high-performance teams.
High school diploma (or equivalency) and legal authorization to work in the U.S.
Preferred Skills and Experience Masters degree in health services research or statistics or related area, or ASA or FSA designation.
Senior leadership experience in a healthcare company.
Business intelligence experience.
Compensation and Benefits
Pay Range:
$135,500.00 - $182,900.00 - $230,300.00 Annual Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job. We offer a comprehensive benefits package which may include:
Medical, dental, and vision insurance
Life insurance
401k
PTO
Volunteer Paid Time Off (VPTO)
And more To discover more about what we have to offer, please review our benefits page. Role Designation
Hybrid Anchored in Connection
Our hybrid approach balances flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week – most teams designate at least one anchor day to ensure team interaction. The rest of the week you are empowered to work remote. Equal Employment Opportunity Statement At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact talent.acquisition@bluecrossmn.com.
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Sprachkenntnisse
- English
Hinweis für Nutzer
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