A Career of Your Calling

About Blue Cross and Blue Shield of Minnesota

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.

The Impact You Will Have

The Director of Risk Adjustment is a key leader responsible for shaping risk adjustment strategies, delivering executional excellence, ensuring regulatory compliance, and leveraging analytics to improve the accuracy and completeness of illness burden assessments. By partnering with internal and external teams and driving data integrity, this role enhances care management, risk mitigation, and financial optimization. The ideal candidate will lead a high-performing team, foster collaboration, and contribute to enterprise-wide decision-making to advance Blue Cross's strategic objectives.

Your Responsibilities

• Responsible for developing and implementing risk adjustment strategies to facilitate accurate and complete coding, reporting, and regulatory compliance with CMS, HHS, and state guidelines. Leads efforts to ensure data integrity, accuracy, completeness and adherence to leading practices in risk adjustment coding.

• Identifies external partner opportunities, supports contracting, and manages external partners in the delivery of best-in-class risk adjustment activities.

• Collaborate with Clinical and Care Management teams to align risk adjustment initiatives with population health, care coordination, and quality improvement programs.

• Oversees risk score computations, diagnostic coding gap identification, benchmarking, and confidence modeling across Medicare, ACA, and Medicaid.

• Manages operational metrics, performance improvement opportunities, and evaluation of in-home assessments, in office assessments, medical record retrieval and coding reviews, and point-of-care programs.

• Provides financial impact analysis, pricing guidance, and budget recommendations.

• Leads Quality and Risk Adjustment analytic activities by fostering a high-performing culture, building strategic partnerships, and influencing organizational decisions.

• Keeps pace with evolving healthcare trends, industry shifts, and competitive dynamics to anticipate challenges and opportunities.

• Effectively communicates insights, strategies, and analytics to senior leadership and stakeholders, ensuring alignment with Blue Cross's long-term vision.

• Directs hiring, training, and development initiatives while maintaining compliance with EEO and Affirmative Action guidelines.

Required Skills and Experience

• 7+ years of relevant professional experience and 3+ years of leadership experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

• Extensive knowledge of CMS risk adjustment regulations, HHS ACA requirements, Medicaid risk adjustment methodologies, and coding standards.

• Ability to evaluate quantitative data from multiple sources using statistical modeling and analytical methods.

• Experience leading Risk Adjustment improvement strategies, coding programs, data submissions, and audit readiness.

• Expertise in analyzing large and disparate datasets, including, enrollment, payment, claims, financial and population health data and meta data.

• Proficiency with methods and tools for data analysis and reporting, such as SQL.

• Proficiency with methods and tools for statistical analysis, performance measurement, and cost analysis. Proficiency with statistical software suites (e.g., SAS, cloud-based platforms), understanding of database structure, relational database concepts, and data architecture.

• Capability to define problems, collect data, establish facts, and draw valid conclusions. Problem-solving skills demonstrated by the ability to approach complex business issues with creative solutions.

• Executive-level communication, facilitation, and presentation skills. Ability to establish trust and build collaborative relationships with key stakeholders within the organization.

• Accepting this position at BCBSMN requires signing an Employee Confidentiality, Intellectual Property Assignment, and Restrictive Covenants Agreement as a condition of employment.

• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experience

• Bachelor’s or master's degree in health services, research, finance, economics or statistics or a related discipline.

• Senior leadership in a healthcare company

• Business intelligence experience

Compensation and Benefits:

Pay Range: $132,300.00 - $178,600.00 - $224,900.00 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
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

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 us at: talent.acquisition@bluecrossmn.com.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.