Government Programs Submissions and Vendor Data Manager

Blue Cross and Blue Shield Association • Baltimore, MD

76d

About The Position

The Government Programs Submissions and Vendor Data Manager serves as an expert in Government Programs for the company, and is responsible for creating processes for oversight of vendors. This role owns the data for Government Programs, including architecture and storage, as well as ensuring proper analysis and forecasting of that data.

Requirements

• Bachelor's degree in related field or any combination of education and experience required to perform the functions of the role
• Minimum 5 years' experience in Medicare Advantage & ACA Risk Adjustment submission experience

Responsibilities

• Maintains expert knowledge of Medicare Advantage & ACA Risk Adjustment models
• Responsible for all formal risk adjustment submissions to CMS or applicable regulatory bodies i.e. RAPS/EDPS/Edge Server or oversight of vendor submissions.
• Develops and maintains systems used for submissions or has oversight of submission vendors
• Oversees and/or participates in regulatory/external party audits related to Risk Adjustment Submissions
• Responsible for technical data exchange between external vendors, CMS and BKC to ensure strong plan performance and initiates corrective action/escalation as needed
• Business Lead/Owner of Government Programs data: architecture, storage, accessibility and responsible for cross team collaboration to achieve program data goals.
• Provides decision support in the form of advanced statistical analysis/business intelligence (Forecasting, Data Mining, Trending and Root Cause Analyses)
• Performs advanced programming and statistical analysis/support for ad hoc requests

Benefits

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: Bachelor's degree