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Salary: USD 120,000 - 138,000 / annual
Bluestone Physician Services is seeking a Program Manager for Risk Adjustment & HCC to lead and optimize the organization's risk adjustment coding operations. Reporting to the SVP of Clinical Operations, you will oversee a team of 2 Risk Adjustment Coders while serving as a strategic bridge between clinical providers, EHR systems, and the Revenue Cycle Management organization.
Key responsibilities include:
• Team Leadership & Management: Directly oversee, mentor, and develop a team of 2 Risk Adjustment Coders. Lead daily operations by managing workload distribution, fostering high team engagement, and driving performance management. Conduct regular 1:1s, provide ongoing training and constructive feedback, and ensure the team maintains high standards of coding accuracy and productivity.
• Standardized Process Development: Design, implement, and manage standardized processes for both proactive (prospective/concurrent) and retrospective risk adjustment queries to ensure accurate capture of patient acuity that are efficient, provider-approved, and compliant.
• Cross-Functional Collaboration: Serve as the primary liaison and foster strong collaboration between the provider network, EHR and clinical teams, and the RCM organization.
• Compliance & Quality Assurance: Ensure all risk adjustment initiatives and coding practices adhere strictly to CMS guidelines, OIG compliance standards, and internal policies. Conduct regular audits and reviews to mitigate risk.
• Provider Education & Engagement: Develop innovative and effective educational materials and feedback loops for providers to improve clinical documentation integrity (CDI) at the point of care.
• Data & Performance Monitoring: Articulate to and collaborate with the analytics team to cultivate the data streams needed to develop KPIs to monitor and objectively evaluate performance, improvement, and areas of opportunity. Track and report on team productivity, HCC capture rates, query response rates, and overall program success.
• Program Innovation: Continuously evaluate current risk adjustment programs to identify opportunities for innovation, efficiency, and revenue integrity, always ensuring that process changes support high-quality patient care delivery.
Bluestonedelivers care to patients with complex, chronic conditions and disabilities through multidisciplinary care teams. The organization has demonstrated measurable outcomes: patients experienced 21% fewer ER visits, 36% fewer hospitalizations, and 41% fewer hospital readmissions compared to similar patient populations. Bluestone has been named to the Star Tribune's Top Workplace list for 14 consecutive years and achieved Top Workplace USA recognition 2021–2026.
This is a hybrid role requiring flexibility to work remotely, conduct field observations, and align on-site. Applicants must reside in Minnesota, Wisconsin, or Florida.
REQUIREMENTS:
• Minimum 5 years of healthcare industry experience with dedicated focus on risk adjustment coding optimization and HCC program management, including previous supervisory or team lead experience.
• CRC (Certified Risk Adjustment Coder) through AAPC is strongly preferred. If you do not currently hold a CRC, you must have willingness to obtain it within an agreed-upon timeframe after hire.
• Preferred: Active CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential.
• Deep understanding of CMS-HCC risk adjustment models, ICD-10-CM coding guidelines, and regulatory compliance requirements.
• Innovation & Strategy: Forward-thinking mindset with proven track record of innovating processes and overcoming operational challenges.
• Collaboration & Leadership: Exceptional interpersonal and communication skills, with ability to build trust, inspire a team, and work effectively across diverse departments (Clinical, RCM, Operations).
• Drive for Success: Highly motivated self-starter with strong desire to succeed and achieve programmatic excellence.
• Patient-Centric Focus: Unwavering commitment to keeping quality and efficient patient care delivery at the heart of all business and operational decisions.
• Influence With & Without Authority: Exceptional interpersonal and communication skills with proven ability to align diverse teams (providers, operational staff, IT, leadership) around shared goals with and without direct line authority.
• Matrixed Accountability: Comfort operating and accepting accountability within a highly collaborative, matrixed organizational structure.
• Analytical Mindset: Ability to convert complex health data and quality metrics into actionable operational strategies.
• Adaptability: Flexibility to thrive in hybrid work environment combining remote strategy, field observations, and on-site alignment.
• Change Management/Process Improvement: Ability to drive change effectively and collaboratively, with eye for processes requiring improvement and efficiency.
• Data and Informatics Fluency: Ability to understand how to develop data streams in concert with EHR and systems available that support or drive workflows necessary to drive outcomes.
