Vice President, Medicare Stars and Risk Adjustment

Blue Cross Blue Shield of Massachusetts•Boston, MA

4d•Onsite

About The Position

The Vice President of Stars & Risk Adjustment Performance is a strategic and analytical senior leader responsible for directing and monitoring all Stars and Risk Adjustment initiatives to achieve optimal outcomes. This role involves developing a unified strategy to drive efficiency and effectiveness across both programs, leveraging data and analytics to improve performance, and maximizing provider engagement to support financial goals. The Vice President will collaborate with key stakeholders to communicate program results and advocate for Medicare business interests in cross-functional projects. This critical leadership position will influence a wide range of partners—including clinical, quality, analytics, member experience, and provider relations teams—to ensure the long-term success of the Medicare Advantage business. The ideal candidate is a natural leader with exceptional communication skills and a persuasive, thoughtful approach. This position will oversee a subject matter expert team for Stars program management and a full Risk Adjustment team, including management, data analysts, and risk coders.

Requirements

A minimum of 15 years of leadership experience in Medicare Advantage Stars and/or Risk Adjustment.
Expert knowledge of Medicare Advantage Stars, Risk Adjustment, Provider Contracting, Product Development, Operations, Finance, and Analytics.
In-depth understanding of the Medicare Part D program, including operations, practices, and industry trends.
Demonstrated strength in analysis, problem identification, and resolution.
Proficiency with Medicare data and system interfaces.
Proven ability to collaborate with corporate planning leaders to execute a strategic plan.
Strong financial and analytical skills.
Excellent written, verbal, and interpersonal communication skills.
Ability to lead and manage deliverables through others in a highly matrixed environment.
Demonstrated ability to take ownership of problems and independently develop solutions.
High degree of professionalism with the ability to interact effectively with all levels of the organization and external parties.
Highly organized and capable of managing multiple projects simultaneously.
Bachelor's Degree required.

Responsibilities

Develop and execute a multi-year business plan for Stars and Risk Adjustment, analyzing the interrelationships of product, operations, and program performance.
Establish, track, and drive performance targets and Key Performance Indicators (KPIs) for both Stars and Risk Adjustment programs.
Lead provider network engagement strategies to improve performance in Stars and Risk Adjustment.
Maintain expert knowledge of CMS regulations, industry trends, and best practices in Medicare Stars and Risk Adjustment.
Lead regular meetings with cross-functional teams, including Pharmacy, HEDIS, CAHPS, HOS, Operations, Provider Network and Analytics, as part of the operational model that includes a hierarchy of steering meetings and domain Stars work groups and specific workgroups with synergies for both Stars and Risk Adjustment Accuracy.
Analyze and communicate the business implications of federal legislative changes, market dynamics, and competitive threats, providing recommendations for action.