Manager, Risk Adjustment Program

Blue Cross and Blue Shield of Vermont


BCBSVT is in the process of standing up a fully functional QHP risk adjustment department. As the company enters the Medicare Advantage marketplace, there will be responsibilities tied to Medicare Advantage risk adjustment activities, though not all of them. Reporting to the Director of Provider Services, this position also will hire 2-3 additional team members as quickly as possible, for a department of 3-4 FTEs reporting to the manager.

Job Description:

The Manager of Risk Adjustment Program participates in and supports the activities for Accountable Care Act (ACA) risk adjustment optimization. The manager is responsible for opportunity analyses for risk adjustment, promotion of capabilities specific to clinical documentation improvement, provider engagement and education, work plan management, and key performance indicators reporting. The position leads a risk adjustment team to ensure initiatives are designed to maintain and enhance proper risk scores for ACA products and to support the Risk Adjustment Data Validation (RADV) and the Initial Validation Audit (IVA) audit process. The position manages the execution of identified risk adjustment opportunities for Medicare Advantage, working with the BCBSVT joint venture partners. If you are interested in more information, please go for more information.

Required Qualifications:

1. BA/BS in business administration, finance, communications, healthcare administration, health information management, or a related field. Degree may be substituted for a minimum of five (5) years’ experience in insurance risk adjustment, coding, and/or auditing.
2. Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Professional Coder (CPC, CPC-P, CCA, CCS, CCSP). Certified Risk Coder (CRC) preferred but not required. Must obtain CRC within 6 months of hire date.
3. Minimum of three (3) years of coding experience strongly preferred.
4. Minimum of five (5) years of supervisory/management experience in medical record coding, billing, and/or practice management.
5. Strong proficiency in Microsoft Office applications (Outlook, Word, Excel, PowerPoint).

Preferred Qualifications:

• Subject Matter Expertise
o Demonstrated proficiency in ICD-10 CM and CPT/HCPCS coding guidelines.
o Knowledge of corporate policies, practices, and structure.
o Detailed knowledge of and experience with Vermont’s health care providers.
o Experience and/or understanding of various Electronic Health Records/Electronic Medical Records systems.
o In-depth knowledge or experience of ACA Commercial Risk Adjustment and/or CMS Medicare Risk Adjustment program methodologies.
• Knowledge of operations within claims processing, provider service, and membership.
• Communication Skills – Excellent verbal, written, and presentation skills.
• Interpersonal Skills – Strong ability to build effective relationships within the company and the broader provider community and to work effectively in a team-based environment.
• Analytical Skills – Strong analytic and problem-solving skills.
• Organizational Abilities – Good organizational skills with ability to prioritize work while meeting scheduled milestones.

Education Qualifications:

See above.


See for more information.

Instructions for Resume Submission:

See for the job application process.

Apply Online:

On the NHHIMA Job Board

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