Full Time Remote Risk Adjustment Coder Jobs in Wichita, KS

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You Belong At Blue

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
• Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
• Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package
  • Incentive pay program (EPIP)
  • Health/Vision/Dental insurance
  • 6 weeks paid parental leave for new mothers and fathers
  • Fertility/Adoption assistance
  • 2 weeks paid caregiver leave
  • 401(k) plan matching up to 5%
  • Tuition reimbursement
  • Health & fitness benefits, discounts and resources

Job Summary

The Medicaid & ACA Manager supports the strategic and operational execution of Medicaid and Affordable Care Act (ACA) programs (individual and small group), serving as a critical operational, analytical, and coordination leader while partnering closely with the Director to translate strategy into disciplined execution. This role is responsible for performance monitoring, insight generation, cross-functional coordination, and execution oversight. The role ensures initiatives impacting medical cost, revenue, regulatory compliance, and member outcomes are effectively planned, executed, and monitored particularly within the ACA Individual and Small Group Markets.

This position is eligible to work remotely, hybrid, or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

What you'll do

• Build and manage detailed workplans, timelines, milestones, and accountability structures across the portfolio
• Oversee day-to-day execution of initiatives, ensuring alignment to financial, operational, and regulatory objectives
• Monitor and interpret key ACA performance indicators (e.g., MLR, risk adjustment/coding capture, enrollment trends, utilization and cost drivers) and support ACA specific analyses related to morbidity shifts, affordability, benefit design, etc.
• Develop and maintain dashboards and recurring performance reports to support leadership decision-making
• Identify trends, risks, and opportunities; convert insights into actionable recommendations and execution support
• Lead cross-functional coordination across Actuarial/Finance, Care & UM, Provider Networks, Operations, and Compliance/Regulatory Affairs
• Facilitate working sessions, manage dependencies, track decisions, risks, and deliverables to drive accountability and ensure initiatives remain aligned with organizational goals
• Support regulatory and compliance readiness (ACA reporting/submissions, audit prep, regulatory inquiries, and corrective action planning/tracking)
• Proactively identify and escalate execution gaps and operational risks, track remediation plans, outcomes, and progress reporting
• Prepare executive-ready materials, performance summaries, and decision-support analyses for senior leaders

Knowledge/Skills/Abilities:

• Strong analytical, critical thinking, and problem-solving skills
• Ability to synthesize complex information into clear, actionable insights
• Excellent written and verbal communication skills, including executive-level presentation
• High attention to detail with the ability to connect tactical execution to strategic goals
• Ability to manage competing priorities in a fast-paced, high-stakes environment
• Collaborative leadership style with confidence and executive presence
• Knowledge of state Medicaid contracts, CMS guidance, and ACA Marketplace operations
• Strong understanding of health plan operations, MLR drivers and cost management levers and Medicaid and ACA regulatory requirements

What you need

Education and Experience:

• Bachelor's degree or equivalent in business administration, health care, public health or related field, required. Master's degree (MBA, MPH, MHA, or equivalent), preferred

• Minimum five (5) years' experience working with Medicaid programs and/or ACA/Individual Marketplace, required

• Minimum three (3) years' experience supervising individuals preferred
• Experience supporting executive leadership and preparing materials for senior leadership or boards, preferred

Physical Requirements:

• Ability to stand or sit for extended periods.
• Ability to look at a computer screen for prolonged periods.
• Occasional walking, bending, or reaching within the office environment.
• Ability to lift and carry up to 15 pounds.
• Ability to bend, kneel, stoop, or reach.
• Ability to perform repetitive tasks.

Compensation

$99,440.00- $124,300.00
Exempt grade 17

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.