Job Description

Use your strengths as a Medicare Risk Program Manager at Wellmark!

About the Opportunity: As a Medicare Risk Program Manager, you will be responsible for the development and maintenance of robust Medicare Risk Adjustment programs to ensure the health plan fully understands the illness burden of our membership. In this critical individual contributor role, you will manage risk adjustment programs, support the strategy execution and analyze risk adjustment program performance data to identify, lead and prioritize strategies to improve risk scoring accuracy in alignment with Wellmark strategies. As a driver of Medicare Advantage (MA) company-identified initiatives, you will be the point-person for driving success on coding accuracy and risk adjustment programs. You won’t do it alone. In this role, you will partner alongside Wellmark, and joint venture, team members focused on program management, analytics, provider performance, and more to drive change and progress.

About you: As this is a newly created role, the opportunity to build out risk adjustment related programs around identified strategies excites you! You are ready to use your MA experience in initiative development, data analytics, medical coding accuracy, risk adjustment, process management, and change management to make an impact. Collaboration is critical in this role, not just internally but externally with Wellmark’s joint venture partner and MA specific vendors. You are organized, flexible, and results-oriented, leading you to take initiative and problem-solve to meet key objectives.

This position will work a hybrid schedule of at least 3 days in Wellmark’s Des Moines, Iowa office, with two days remote option.

Internal Job Title : Medicare Risk Program Performance Manager

Qualifications

Preferred Qualifications:

• 2+ years of experience in managing Medicare Advantage Risk Adjustment programs.
• Knowledge of industry standard ICD-10-CM and CPT coding principles.
• Certified Risk Adjustment Coder (CRC).

Required Qualifications:

• Bachelor's degree or direct and applicable work experience.
• 4+ years of related healthcare industry experience.
• Experience in the development & management of healthcare-related programs, which includes leading projects from ideation through execution and working in a highly matrixed environment with both internal and external partners.
• Knowledge of CMS rules and requirements of Medicare Advantage Health Plans.
• Demonstrated ability to think strategically to ensure program success.
• Demonstrated experience influencing stakeholders.
• Excellent analytical skills, data management capabilities, and strong attention to detail. Ability to review data and provide measurable outcomes and trend measures to support and influence business decisions.
• Technical aptitude to learn new data management and analysis tools or methodologies quickly.
• Strong analytical, problem solving, and critical and strategic thinking skills. Willingness to take an innovative, creative approach to solving problems and developing solutions.
• Strong written and verbal communications skills with the ability to share technical insights and recommendations with varying stakeholder audiences, including healthcare providers and external vendors. Adapts communication based on audience.
• Self-starter motivated by the opportunity to work in fast-paced environments and driven by measurable outcomes. Effective time management with flexibility and adaptability to change.
• Strong organization, time management, and prioritization skills. Ability to manage multiple projects while adjusting to changing priorities and business needs.
• Collaborative approach to work with and ability to partner with different business areas.
• Proficiency with the Microsoft Office Suite.

Additional Information

What you will do as a Medicare Risk Program Manager:

a. Develop and maintain a Risk Adjustment work-plan and convene committees and workgroups as needed.

b. Responsible for implementation and oversight of risk adjustment related initiatives and projects.

c. Partner with internal teams and associated external vendor partners to monitor program and vendor performance, facilitate oversight and performance improvement activities as needed.

d. Collaborate with internal and external teams to ensure complete and accurate reporting of risk adjustment data in accordance with Centers for Medicare and Medicaid Services (CMS) requirements.

e. Analyze risk program performance data to identify and prioritize strategies to help achieve risk adjustment program objectives.

f. Coordinate and develop indicators related to risk adjustment operations to inform leadership on progress of activities and risk adjustment programs.

g. Partner with internal stakeholders and/or external vendors in the definition, design, implementation, and maintenance of data files and data extracts to meet reporting needs of Wellmark’s coding accuracy initiatives.

h. Apply and maintain knowledge of applicable current and proposed laws, regulations, and CMS guidance applicable to risk adjustment specifically, and general knowledge of Medicare Advantage and ACA/Exchange based requirements.

i. Collaborate with Medicare Advantage Network Performance team in support of delivering provider education to facilitate clinical documentation improvement and improve provider performance and outcomes.

j. Other duties as assigned.

This job requires a non-compete agreement.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us atcareers@wellmark.com

Please inform us if you meet the definition of a "Covered DoD official".