Program Manager, Risk Adjustment Coding and Quality

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing.

If you are ready to make a difference, join us.

Blue Cross and Blue Shield of Minnesota is hiring a Program Manager, Risk Adjustment Coding and Quality. In this position, you’ll be responsible for the design, implementation, evaluation, and ongoing management of the Risk Adjustment Coding and Quality Program, supporting Medicare, Medicaid, ACA, and Commercial populations to optimize Blue Cross’s earned risk-adjusted revenue. The role serves as the subject matter expert for risk adjustment coding, partnering with leadership and cross‑functional teams to develop and execute strategic initiatives, identify data trends, and implement performance improvement opportunities through collaboration with analytics and other key stakeholders.

The incumbent ensures program strategies and operations meet evolving regulatory, market, provider, and member requirements while addressing complex business challenges and supporting organizational change. Acting as a liaison across multiple departments, the individual leads enterprise‑wide initiatives, drives results within established timelines, and provides leadership and oversight to program management staff within the division. Working closely with the Director, this position supports the implementation of strategic initiatives, monitors project progress, and oversees team and vendor performance to ensure key objectives and deadlines are achieved.

The role leads coding and audits review activities, including medical record reviews to support accurate risk adjustment revenue, compliance, audits of provider and vendor documentation to ensure accuracy and completeness, and operational readiness efforts for government audits related to risk adjustment programs.

• Lead Medicare Advantage (MA) and ACA Risk Adjustment coding operations, including chart review programs, RADV and HRADV audit readiness, and coding validation activities to ensure accurate risk score capture, regulatory compliance, and revenue optimization. Expert in HCC and HHS risk adjustment methodology.
• Manage and develop a team of certified coding professionals (CPCs), providing leadership, oversight, and coaching while driving coding accuracy, quality performance, and operational excellence.
• Partner with providers, vendors, and cross‑functional stakeholders to deliver risk adjustment education, ensure vendor performance and compliance, and implement strategies that improve documentation quality and audit outcomes.

• Drive the development and documentation of design, requirements and implementation required to support initiatives that align with strategic priorities.
• Develop relationships and partner with key resources, both internal and external, to collaborate on the design and ensure all market, member, and provider considerations are factored into the design.
• Drive business decision making process to ensure capabilities, systems and processes meet market expectations and that alternate approaches are vetted and explored.
• Manage related ongoing program management work to understand what is needed to recommend strategy and solutions, while influencing and steering others to accomplish that strategy across multiple complex programs.
• Ensure that appropriate metrics are chosen and that the appropriate measurement, data analysis and…