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Enterprise Risk Adjustment Submissions Manager

Req ID: R0003920 Career Area: Customer Service/Operations Date Posted: 09/07/2023
About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

The Manager of Enterprise Risk Adjustment Submission Quality leads a team to deliver results that support enterprise risk adjustment optimization across Medicare, Medicaid, and ACA Commercial populations. This position is responsible for delivering technical systems and operational support to improve the quality of data submissions to CMS and MN DHS.This positions manages the Enterprise Risk Adjustment Submissions Team to deliver these services, ensuring successful technology support of data submission, management of error reports, and reconciliation of errors.

A Day in the Life:

  • Manage the Enterprise Risk Adjustment Submissions Team responsible for technical tools, data systems, reports and data extracts, workflow processes, and operational supports.
  • Ensure the priorities of the Submissions Team reflect departmental and division goals and support optimization of risk-adjusted revenue.
  • Ensure the teams knowledge, skills, and abilities meet current and evolving needs.
  • Identify and solve for technical enterprise risk adjustment submissions needs, including evaluating potential systems and vendors, and/or designing technology solutions.
  • Develop project plans and time lines for implementation of identified vendor solutions.
  • Collaborate with internal parties and vendors to successfully execute customized implementations or resolution of escalated issues.
  • Build and manage vendor and internal relationships with assigned submission vendors to maximize program efficiencies.
  • Ensure risk adjustment methods are in compliance with CMS and state mandated regulations.
  • Stays abreast of CMS and DHS changes, guidance, and direction to ensure flawless completion of the technical submissions process to maximize Blue Cross receipt of risk-adjusted revenue.
  • Collaborate with IT to design and deliver data outcomes that comply with CMS and DHS/state mandated regulations.
  • Brings rigor to the process of data submissions with exceptional attention to detail, including identification of errors and their remediation.
  • Identify and/or support technical improvements and innovations to maximize revenue opportunities with clearly defined scope, timelines, impact and deliverables in partnership with finance, actuarial, product, sales and network.
  • Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensures employees receive the proper training.
  • Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, discipline, employee relations and cost control.

Required Skills and Experiences:

  • Bachelors degree in Business, Finance or a related field and 7 years of progressive experience that includes operations and technology across various functions of the organization or 12 years of related experience in lieu of degree.
  • 3+ years of leadership experience with staff management, including performance management, coaching, and mentorship.
  • Experience with technology operations, including project lifecycles, design, testing, tracking, risk mitigation, and business implementation.
  • Strong creative thinking, problem-solving, and critical thinking skills.
  • Proven project management experience with the ability to track and manage projects to ensure work is completed as required and deadlines are met in a collaborative setting.
  • Demonstrated ability to analyze and interpret data and develop strategic recommendations.
  • Excellent communication and interpersonal skills.
  • Clearly and effectively communicates technical concepts, issues, and solutions to non-technical audiences.
  • Demonstrated collaboration and consultation skills. Strong Financial background.
  • Ability to lead others and build relationships.
  • Demonstrated delegation and management skills and prior experience.

Nice to Have:

  • 4 years of risk adjustment submissions experience (Commercial /Medicare/Medicaid combined).
Make A Difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

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