CareFirst Careers

ACA Risk Adjustment Supervisor

Resp & Qualifications

PURPOSE: This role will require the incumbent to support the Finance Division management with monitoring and implementing procedures, controls and processes related to the Affordable Care Act (ACA). The responsibility of the incumbent is to manage multiple projects related to Commercial risk adjustment (ACA) campaigns.  The Supervisor will lead the management and day-to-operations of the Risk Adjustment Data Validation (RADV) audit and any risk adjustment project activities including scope, capacity planning, resource allocation, costs and timing while minimizing financial and compliance risks.  Working closely with cross functional teams, the campaign manager is responsible for monitoring the day to day performance levels both internally and externally, which include our third party vendors, to ensure campaign success in  accomplishing  expected outcomes and compliance with federal regulations.

This position reports to  the Director of ACA Financial Controls and Revenue Management and works hand-in-hand to provide support to manage, measure, and communicate new and ongoing activities, including vendor and consultant activities, involving Risk Adjustment, RADV and various other ACA related tasks.


Manage the risk adjusmtent and RADV audit projects to include the following:
• the coordination and reporting of data from outside vendors to support all projects.
• Monitor the results and alert upper manamgent of any potential issues
• Work with other internal divisions to ensure project requirements are met and the projects are fully support.
• Ensure the accuracy and completeness of data such as EDGE database support, RADV audit, Risk Adjustment and other programs.
• Ensure coding needs and record retrieval needs are met
• Fully support the provider contact data base used for medical record retrieval.
• Act as Liaison vendors and providers ensuring that a professional and healthy relationship is maintained. Provide all support required of the provider to ensure retrieval of medical records.

Independently support the development of  sophisticated analytics based on financial and healthcare concepts to:
• Validate accuracy of risk score data in the HIX database and the EDGE server.
• Perform complex analysis of medical health data to leverage most impactful information for medical records chase lists and medical record coding.
Ensure data from the federal government and our third party vendors is accurate and complete.

Manage and supervise the team that supports the risk adjustment projects and the ACA RADV IVA audit.  This includes the medical coder functions and the medical record retrieval functions.

Support the attestation and discrepancy process with CMS working with the Data Warehouse team and the actuaries to assess accuracy and completeness and resolve any potential discrepancy.  In addition, ensuring compliance with all government regulations and requirements.

Assist Director in managing projects to develop and implement Revenue Performance short-term and long-term . to improve our risk adjustment results.

• This position requires a Bachelors in accounting, finance, or business, or equivalent work experience and a minimum of 6 years of progressively responsible financial and/or audit experience with time spent in a health insurance oriented organization. 
• Incumbent must have demonstrated expertise in accounting, audit, business analytics or financial operations. Incumbent must be analytical and able to identify problem areas quickly, and must have knowledge of PC and mainframe based applications. 
• Position requires flexibility in meeting deadlines, and a team oriented perspective.
• Understanding of all financial regulations and experience implementing the appropriate internal controls to maintain compliance.  

• Advanced analytical and financial modeling skills. 
• Advanced abilities in Excel and other database applications. 
• Solid organizational, problem solving and interpersonal skills. 
• Ability to work with personnel at all levels of the organization. 
• Excellent written, oral and presentation communication skills to convey complex and technical issues to a diverse audience. 
• Extreme flexibility in meeting deadlines, and team-oriented perspective. Active change agent within and outside Finance.
• This position requires a high degree of interpersonal skills, and incumbent must be able to effectively manage and cultivate development of staff. 

Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.  Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.   Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

• Demosntrated experience leading people either indirectly or directly is highly desired.
• It is preferred that the incumbent possess or is pursuing the following degrees or certifications: CPA, MBA, or CMA.  Experience implementing ACA related financial controls.


Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply:

Closing Date

Please apply before: 8/16/2020

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.


The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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