Hiring: Risk Adjustment Business Operations Director (Hybrid) Company: CareFirst BlueCross BlueShield Location: Baltimore, MD Job Posted Time: 2026-09-17 10:49:29 Target Skills & Keywords : Medicaid, Medicare, Regulatory Compliance About the job Experience: •8 years of progressive responsibility in healthcare. •3 years specifically in risk adjustment environment, within healthcare insurance within Government Programs (MA & Medicaid) & ACA. Required Skills: •This position manages people - 1-5 5-10 Qualifications: •Bachelor's Degree in Health Care Administration, Public & Population Health, Finance, Business Analytics, or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. •Masters in Business Administration, Masters in Health Administration or Masters in Public or Population health or a related field. •Extensive experience leading Risk programs for Medicaid, Medicare Advantage, and ACA/BHP populations, including RADV, encounter data, and ACA EDGE submissions. •Deep knowledge of CMS regulations, HCC coding methodologies, risk adjustment operations, provider engagement strategies, and healthcare regulatory requirements. •Proven ability to drive enterprise-wide performance improvement through analytics, KPI/OKR development, program governance, regulatory compliance, and cross-functional stakeholder collaboration. •Demonstrated success leading high-performing teams and strategic initiatives while partnering with executive leadership, actuarial, quality, network, finance, and operational departments to achieve organizational and financial objectives. •Knowledge, Skills And Abilities (KSAs) •Knowledge and experience across all regulatory guidelines on Risk Adjustment. •Successful completion of a Coding Certificate program from an accredited organization (i.e., CPC, CRC, CPMA from AAPC, or CCS, CCS-P from AHIMA. •Strong leadership skills, Risk Adjustment financial acumen, vendor oversight skills & an experience in payer, provider & industry collaboration. Compensation: •$140,640 - $261,063 / year •Competitive benefits and rewards package 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!