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 2.9 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us. Please note that effective 11/23/2021, all associates must be fully vaccinated for COVID19 unless legally entitled to a reasonable accommodation related to religious or medical exemptions.

How Is This Role Important to Our Work?

The Manager ERA Program Analytics leads a team of Healthcare Analysts that support Enterprise Risk Adjustment (ERA) optimization across Medicare, Medicaid and Individual/Small Group Commercial population.The Manager ERA Program Analytics position leads a team responsible for delivering insights that serves to support Risk Adjustment Optimization efforts to improve the quality of care as well as to manage the risk of Blue Cross Blue Shield of Minnesota members.This work includes leadership to develop and prioritize efforts which will improve the situational awareness of risk adjustment optimization opportunities and effective target identification to close suspected and actual gaps in coding and care delivery.In this role, the Manager works closely with the Director of Enterprise Risk Adjustment Analytics and other teams in the Center of Excellence to understand retrospective interventions, to define the scope of technical requirements, to lead teams to develop analytic solutions and quantitative analyses for risk adjustment and to manage a team of data analysts to produce deliverables in a timely manner.This work requires a commitment to best-in-class analytics and a willingness to effectively engage in a matrixed environment to champion a data driven culture to Enterprise Risk Adjustment efforts.The position will call upon a broad understanding of Health Services Research, Risk Adjustment and health policy, as well as the technical nuances of various risk adjustment HCC and CDPS models for Medicare, ACA Commercial and Medicaid. This position will manage employees, including skill and career development, policy administration, discipline, employee relations, goal setting, and performance reviews.

A Day in the Life:

• Leads the development of ERA Program Analytics and collaborates with the Advanced Analytics Manager to address key strategic problems such as the accurate identification of members for gap closure and quality improvement opportunities through data analytics that will drive improved performance on Center of Excellence initiatives.
• Development of ERA Program Analytics that would help Leadership answer the question of whether we are focused on the right members, the right types of gaps in coding and care, how much we have improved the accuracy and completeness of BCBS-MN diagnostic data, what opportunities remain, and estimate the value of those opportunities to drive risk adjustment strategy and mitigate risk.
• Serves as a key leader on Risk Adjustment by maintaining current knowledge of the business content, regulatory knowledge, best practices, analytical methods and knowledge of diverse data sources-and systems necessary to support the efforts of ERA analytics initiatives.
• Fosters the professional development of other team members, the improvement of internal processes, the enhancement of existing products and services, the creation of new offerings, and the informed development of ERA analytics business strategy.
• Collaborates to manage, grow, and develop relationships with other analytic teams and leaders at BCBS-MN, thus actively contributing to the empowering of internal BCBS-MN analytics and the retention of talent.
• Effectively communicates complex Risk Adjustment concepts, strategies, initiatives, analytics, and results to a variety of stakeholders, including senior staff and leadership. Understands the strategy and future direction of Blue Cross, as well as challenges and opportunities that are inherent to that strategy and direction. Ensure that the priorities of the team reflect the company's strategic direction, and ensure the teams knowledge, skills, and ability are adequate to meet current and evolving needs for risk adjustment optimization.
• Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines, company policy and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.

Nice to Have:

• Bachelor's degree.
• Masters degree in health services research or statistics or related area, or ASA or FSA designation.

Required Skills and Experiences:

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Experience with health-related data analysis.
• 3+ years of mentorship and leadership in Risk Adjustment Analytics.
• 3+ years of demonstrated experience of programming using risk adjustment models for Medicare, Medicaid and ACA Commercial, computing risk scores and evaluation of risk scores output for quality.
• Demonstrated ability to evaluate quantitative data from multiple sources using statistical analysis and critical thinking skills.
• Demonstrated experience with statistical software suites (e.g. SAS, R, Stata); strong understanding of database structure, relational database concepts, and exposure to Unix environments.
• Ability to define problems, collect data, establish facts, and draw valid inferences.
• Strong problem-solving skills exhibited by the ability to approach complex, ambiguous business issues with creative ideas and solutions.
• Superior communication, facilitation, and presentation skills.
• Demonstrated experience in collaboration, teamwork, and cross-functional communication.
• Effective, concise, and professional written, verbal and presentation skills.
• Knowledge of healthcare industry including familiarity with health policy, health insurance,benefit plans and product features, provider contracting approaches, reimbursement approaches and health management approaches.
• Flexible, self-motivated, and continuously seeking ways to improve.
• High level organizational and project management skills in order to effectively handle multiple concurrent assignments.

Role Designation:

Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.

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 [email protected].

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.