A Career of Your Calling

The Impact You Will Have

Blue Cross Blue Shield of Minnesota is hiringa Directorof Risk Adjustment Analytics. The Director of Risk Adjustment Analytics leads a team that delivers insights and results in support of the Risk Adjustment program. This position plays a leadership role in enabling improved accuracy in understandingtheillnessburden of our membership to better manage their risk, care, and health.

Your Responsibilities

• Performs risk score computation and forecasting for Medicare, ACA, and Medicaid.

• Overseesdiagnostic coding gap identification (suspecting), confidence modeling, and benchmarking.

• Responsible for operational metric tracking and performance improvement opportunity identification.

• Involved with the targeting and evaluation of in-home assessment, chart review, and point of care programs.

• Calculatesthefinancial impactof 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 adjustmentinitiativesperformance across Medicare, ACA, and Medicaid throughout the year.

• Identifiesand escalates potential data leakage issues for operational teams to address.

• Drives the design, development, and maintenance of dashboards tomonitorrisk adjustment initiatives and outcomes.

• Collaborates with provider engagement teams to track andreportprovider performance metrics.

• Provides audit support for RADV, OIG, and other regulatory or internal audits.

• Provides strong leadership to theRisk Adjustment Analytics team, including building a successful team, developing strategic partnerships, andinfluencing acrossBlue Cross highly matrixed organizational structure torepresententerprise risk adjustmentinterests.

• Stays abreast of changes in the rapidly evolving health care marketplace and understands how trends, competitors, external context, and internal dynamics 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, as well as challenges and opportunities that are inherent to that strategy and direction.

• Ensure that the priorities of the team reflect the company’s strategic direction, and ensure theteamsknowledge, skills, and ability are adequate to meet current and evolving needs of the Risk Adjustmentprograms.

• Directs the team, including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training.

• Conducts performance evaluation, andis responsible formanaging employees, including skill and career development, policy administration,coaching onperformance management and behavior, employee relations, and cost control.

Required Skills and Experience

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

• 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.

• Demonstrated ability to evaluate quantitative data from multiple sources using statistical modeling, analytical methods, and critical thinking skills.

• 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 databaseconceptsand data architecture.

• Ability to define problems, collect data,establishfacts, and draw valid conclusions.

• Strong problem-solving skillsexhibitedby the ability to approach complex, ambiguous business issues with creative ideas and solutions.

• Superior executive level communication, facilitation, and presentation skills.

• Proven ability toestablishtrust and build collaborative relationships with key constituents (internal leaders and experts across the organization).

• Ability to navigate ambiguity in a complex, matrixed environment.

• Must be a strategic thinker, witha high levelof intellectual curiosity and openness to change.

• Proven ability to perform complex business analysis and decision-making, with the ability to effectively analyze and synthesizelarge amountsof complex data in relevant insights.

• Demonstrated experience in collaboration, teamwork, and cross-functional communication.

• Demonstrated ability to communicate acrossa large, complex health care organizations and deliver persuasive messages based on thorough fact-based analysis.

• Effective, concise, and professional written, verbal and presentation skills.

• Knowledge ofhealthcareindustryincludingfamiliarity with health benefit plans and product features, provider contracting approaches, reimbursementapproachesand health management approaches.

• Flexible, self-motivated, and continuously seeking ways to improve.

• Demonstrated leadership ability exemplified by a capacity to think strategically and implement tactically to consistently deliver results; well-developed skills in diplomacy and collaboration; and ability to develop and lead high performance and collaborative teams.

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

Preferred Skills and Experience

• Mastersdegree in health services researchor statistics or related area, or ASA or FSA designation

• Senior leadership experience in a health care company

• Business intelligence experience