Manager Retrospective Risk Adjustment

Blue Cross and Blue Shield of Kansas is looking to add to our leadership team and has an opportunity for a Manager of Retrospective Risk Adjustment. This position is responsible for leading staff in designing and executing retrospective chart retrieval and coding programs for Affordable Care Act (ACA) risk adjustment and Medicare Advantage (MA) risk adjustment, including the delivery of risk adjustment improvement initiatives in coordination with multiple corporate divisions and vendors. Position works jointly with Actuarial Research, Accounting, Provider Network Solutions, Medical Affairs, Compliance, Government Programs, and Information Technology & Services to generate meaningful reports and identify and act on risk adjustment opportunities. Position manages multiple vendor relationships and processes to ensure data integrity.

“This position is eligible to work hybrid (after 6 months of onsite training) or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

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Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Lead and Inspire: Guide and mentor your team to achieve their full potential and success.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Stability: 80 years of commitment, compassion and community

Compensation

$112,800 - $134,000

Exempt Grade 18

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid.  All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

What you’ll do

• Oversee all retrospective risk adjustment coding vendor communications and contract renewals, including maintaining joint timelines, ensuring timely deliverables, setting expectations, holding vendors accountable, documenting decisions, and negotiating terms. Maintain and expand EMR/EHR access with external entities to support accurate and timely data retrieval.
• Lead and manage a team responsible for chart retrieval and coding, including hiring, onboarding, performance evaluations, coaching, and disciplinary actions. Foster a collaborative and high-performing team culture aligned with organizational goals.
• Oversee and enhance the risk adjustment, HEDIS, and MA optimization record retrieval and medical record coding processes, including the transfer and organization of medical record files and coding output for any outsourced activity
• Review CMS communications pertaining to ACA/MA risk adjustment and recommend policy and procedure changes in collaboration with Compliance staff.
• Monitor ACA and MA risk adjustment reporting and review data quality reports prior to approval and submission to CMS
• Regularly review and improve the use of analytic tools to identify opportunities to improve the accuracy of member risk adjustment and MA Stars scores.  Develop chase lists for medical records and health risk assessments for use in outreach to providers and members. Improve processes by finding and pursuing opportunities to utilize alternative data that may improve the timely and accurate identification of member health conditions
• Create, analyze and report chart retrieval and coding trends in ACA/MA risk adjustment data throughout each calendar year. Maintain the analysis and reporting models as needed and identify and develop model improvements
• Create and communicate strategic solutions that are clear, defensible, and actionable across internal and external stakeholders
• Develop, manage and/or assist with the development of ACA/MA risk adjustment improvement initiatives & incentive programs
• Collaborate and innovate across product, operations and IT teams. Evaluate industry best practices and partner with internal teams to enhance tools and infrastructure.
• Prepare ad-hoc reports as needed