Bcbsla
Director, Prospective Risk Adjustment Operations
Corporate - Baton Rouge, LA · Director · Contract
Sponsorship not specifiedDetected 12 days ago
Project ManagementProcess ImprovementVendor ManagementPerformance ManagementHRISPublic HealthLeadershipCommunicationCollaboration
About the role
- We invite you to apply for a career with us.
- Job duties are performed in a normal and clean office environment with normal noise levels.
- Work is predominately done while standing or sitting.
Responsibilities
- Demonstrated ability to lead organizational change and drive measurable results through cross-functional collaboration.
- Leads the development and execution of enterprise-wide prospective risk adjustment operational strategies.
- Develops, deploys, and scales Clinical Documentation Integrity (CDI) programs focused on suspected and previously coded conditions, practice transformation initiatives, and payer-provider process integration.
- Leads initiatives designed to improve member participation in prospective risk adjustment activities.
- Develops new outreach strategies targeting members at risk of non-engagement.
- Partners with internal stakeholders to integrate risk adjustment communications and interventions throughout the member lifecycle.
- Builds and maintains relationships with vendors and strategic partners that support prospective coding accuracy initiatives.
Requirements
- Strong knowledge of prospective risk adjustment principles, HCC coding methodologies, and documentation integrity practices.
- Ability to analyze complex operational and performance data and translate findings into actionable business strategies.
Nice to have
- Master's degree preferred.
Skills
- Knowledge, Skills, and Abilities
- Strong communication, relationship management, and influencing skills.
- Strong project management, process improvement, and vendor management skills.
Compensation
- The Director oversees Clinical Documentation Integrity (CDI), provider engagement, Annual Wellness Visit initiatives, in-home and telehealth assessment programs, and other prospective risk adjustment interventions designed to drive accurate
Benefits
- Engages providers to improve documentation quality and coding accuracy through education, performance reporting, and consultative support.
- Oversees integration of Annual Wellness Visit outreach efforts into existing member engagement programs.
- Oversees Comprehensive Health Evaluation programs, including in-home and telehealth health assessments.
- Collaborates with healthcare analytics, provider organizations, value-based care teams, population health, compliance, and clinical leadership to advance prospective risk adjustment goals.
This listing is sourced directly from Bcbsla's careers page and normalized into a canonical job model.