Hiring: Manager, Medicare & Commercial Risk Adjustment Company: Blue Cross Blue Shield of Massachusetts Location: Hingham, MA Job Posted Time: 2026-09-15 10:40:37 Employment Type: Full-time Target Skills & Keywords : Clinical Documentation, Health Information Management, ICD-10, Medicaid, Medicare, NLP, Quality Assurance About the job Required Skills: •The Manager acts as a subject matter expert on MA (CMS-HCC, CMS-RADV) guidelines as well as ACA (HHS-HCC, HHS-RADV) requirements, working closely with the RADV Compliance Senior Manager to support audit readiness across internal and external (CMS-RADV, HSS-RADV) audit cycles. •Lead and develop a team of certified professional coders and quality assurance auditors. •Oversee vendor and offshore coding partners to ensure consistent quality and compliance. •Ensure accurate and compliant diagnosis coding to support MA and ACA risk adjustment models across RA coding operations. •Validate medical record reviews and QA reviews to confirm diagnostic documentation aligns with coding submissions. •Implement and manage quality assurance coding review programs to monitor coding accuracy and compliance. •Support and facilitate audit readiness activities spanning internal auditing and monitoring and CMS-RADV, HHS-RADV, and other regulatory audit requirements. •Partner cross-functionally with compliance and audit teams to resolve findings and ensure corrective actions are implemented. Qualifications: •Bachelor's Degree in Business Administration/Management, Health Information Management, Healthcare Administration, or equivalent; OR minimum of five (5) years of relevant experience in lieu of a degree. •Certified Professional Medical Auditor (CPMA) or Registered Health Information Administrator (RHIA) – Preferred •High school degree or equivalent required unless otherwise noted above •This job is also eligible for variable pay. •We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees. •WHY Blue Cross Blue Shield of MA? Compensation: •$104,040 - $127,160 / year Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!