Hiring: Risk Adjustment Manager - Prospective (Hybrid) Company: CareFirst BlueCross BlueShield Location: Reston, VA Job Posted Time: 2026-09-12 11:49:29 Employment Type: Hybrid Target Skills & Keywords : Clinical Documentation, Medicaid, Medicare About the job Experience: •5 years experience of progressive responsibility in a healthcare payor environment, 1 year experience with supervisory or demonstrated progressive leadership experience within Government Programs and Risk Adjustment functional areas Required Skills: •Act as a liaison between the business units and the risk adjustment group by promoting a positive environment of collaboration and excellent customer service. Serve as an SME to guide the key stakeholders in bid filings, regulatory filings, and financial performance planning and reporting. •This position manages people. Qualifications: •Bachelor's Degree 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. •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, vendor oversight skills and an experience in payer, provider and industry collaboration. •Demonstrated capacity to work in a fast-paced environment and drive consistent actions across a matrixed environment. Compensation: •$105,040 - $194,981 / 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!