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Manager Hcc Risk Adjustment Jobs in Virginia (NOW HIRING)

Aledade

Vice President, Risk Adjustment, Remote

Arlington, VA · On-site +1

$145K - $194.40K/yr

Partner with clinical teams, care management, and leadership to effectively communicate risk assessments and implement targeted interventions based on risk stratification results. Minimum ...

Augusta Health

Clinical Doc Spec - Outpatient

Fishersville, VA · On-site

$35.25 - $47.25/hr

... risk adjustment and HCC capture. This role would report to Pop Health but would work with the Augusta Medical Group (AMG) providers to support the providers by validating diagnoses, improving ...

Humana

Clinical Coding Educator

Dale City, VA · On-site +1

Will report to the Manager, Medicare Risk Adjustment As the Clinical Coding Educator / Coding Educator 2 you will * Arrange educational sessions with assigned providers aimed at quality of care and ...

Humana

Clinical Coding Educator

Strasburg, VA · On-site +1

Will report to the Manager, Medicare Risk Adjustment As the Clinical Coding Educator / Coding Educator 2 you will * Arrange educational sessions with assigned providers aimed at quality of care and ...

Humana

Clinical Coding Educator

Virginia Beach, VA · On-site +1

Will report to the Manager, Medicare Risk Adjustment As the Clinical Coding Educator / Coding Educator 2 you will * Arrange educational sessions with assigned providers aimed at quality of care and ...

Humana

Clinical Coding Educator

Annandale, VA · On-site +1

Will report to the Manager, Medicare Risk Adjustment As the Clinical Coding Educator / Coding Educator 2 you will * Arrange educational sessions with assigned providers aimed at quality of care and ...

Humana

Clinical Coding Educator

Pulaski, VA · On-site +1

Will report to the Manager, Medicare Risk Adjustment As the Clinical Coding Educator / Coding Educator 2 you will * Arrange educational sessions with assigned providers aimed at quality of care and ...

Humana

Clinical Coding Educator

Springfield, VA · On-site +1

Will report to the Manager, Medicare Risk Adjustment As the Clinical Coding Educator / Coding Educator 2 you will * Arrange educational sessions with assigned providers aimed at quality of care and ...

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Manager Hcc Risk Adjustment information

What are the key skills and qualifications needed to thrive as a Manager HCC Risk Adjustment, and why are they important?

To thrive as a Manager HCC Risk Adjustment, you need expertise in healthcare coding (especially ICD-10), risk adjustment methodologies, and a background in health administration or a related field, often supported by a relevant degree and coding certifications like CRC or CPC. Familiarity with risk adjustment analytics platforms, EHR systems, and healthcare data reporting tools is important. Strong leadership, analytical thinking, and effective communication skills enable you to guide teams and collaborate across departments. These skills and qualifications are essential to ensure accurate risk scoring, regulatory compliance, and optimal reimbursement for healthcare organizations.

How does a Manager HCC Risk Adjustment typically collaborate with other departments to ensure accurate risk scoring?

A Manager HCC Risk Adjustment frequently partners with coding teams, clinical staff, and data analysts to ensure that documentation and coding accurately reflect patient conditions for risk adjustment purposes. This collaboration often involves leading training sessions, reviewing charts for compliance, and coordinating audits to identify documentation gaps. Working closely with these departments helps ensure data integrity, optimize risk scores, and support organizational goals related to reimbursement and quality reporting.

What are Manager HCC Risk Adjustment jobs?

Manager HCC Risk Adjustment jobs involve overseeing teams and processes that assess and improve Hierarchical Condition Category (HCC) coding and risk adjustment in healthcare organizations. These managers ensure accurate documentation and coding of patient diagnoses to optimize reimbursement and compliance with government regulations. They collaborate with coders, clinicians, and data analysts to monitor performance, provide training, and implement best practices. Their role is critical in maximizing risk-adjusted revenue while maintaining high standards of patient data integrity.

What is the difference between Manager Hcc Risk Adjustment vs Hcc Risk Adjustment Specialist?

AspectManager Hcc Risk AdjustmentHcc Risk Adjustment Specialist
CredentialsTypically requires a bachelor’s degree, industry certifications (e.g., CPC, CCS), and experience in healthcare or risk adjustmentOften requires similar certifications and experience but may have less managerial responsibility
Work EnvironmentSupervises teams, manages projects, and collaborates with multiple departmentsFocuses on data analysis, coding, and risk adjustment tasks, often working independently or in small teams
Employer & Industry UsageCommonly employed by health plans, healthcare providers, and risk adjustment vendorsFound within similar organizations, often as a specialized role supporting risk adjustment processes

The main difference is that the Manager Hcc Risk Adjustment oversees teams and manages projects, while the Hcc Risk Adjustment Specialist focuses on technical tasks like data analysis and coding. Both roles require relevant certifications and industry experience, but the manager role involves leadership responsibilities.

What are the most commonly searched types of Hcc Risk Adjustment jobs in Virginia? The most popular types of Hcc Risk Adjustment jobs in Virginia are:
What are popular job titles related to Manager Hcc Risk Adjustment jobs in Virginia? For Manager Hcc Risk Adjustment jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Manager Hcc Risk Adjustment jobs in Virginia look for? The top searched job categories for Manager Hcc Risk Adjustment jobs in Virginia are:
What cities in Virginia are hiring for Manager Hcc Risk Adjustment jobs? Cities in Virginia with the most Manager Hcc Risk Adjustment job openings:
Manager Hcc Risk Adjustment jobs near you
Infographic showing various Manager Hcc Risk Adjustment job openings in Virginia as of May 2026, with employment types broken down into 93% Full Time, 5% Part Time, and 2% Contract. Highlights an 71% In-person, 2% Hybrid, and 27% Remote job distribution.
Consulting Actuary - ACA Risk Adjustment

Consulting Actuary - ACA Risk Adjustment

Blue Cross and Blue Shield of North Carolina

Virginia Beach, VA

$143.62K - $229.79K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 25 days ago

Blue Cross and Blue Shield of North Carolina rating

7.8

Company rating: 7.8 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

163rd of 259 rated insurance

Job description

Job Description

As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include leading pricing strategies and actuarial initiatives for business segments, evaluating advanced care management models, conducting competitive benchmarking analyses, and designing and pricing sophisticated insurance products. You will support company objectives by providing reliable, actionable actuarial insights and recommendations, proactively identifying and addressing complex risks and opportunities. This position requires adaptability to the evolving landscape of the industry, ensuring our actuarial practices remain at the forefront of innovation and excellence.

What You'll Do

  • Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work

  • Provide proactive and strategic thought leadership of ways to improve processes, reduce risks, and meet department and enterprise objectives to achieve profitable growth and/or improve value, quality, and access for Blue Cross NC customers

  • Achieve segment financial targets and provide concise explanations of results and variances to expectations; act as a financial steward for the company

  • Communicate effectively with all levels and divisions within the organization, including Divisional Leadership

  • Manage external partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts and/or rates

  • Develop and maintain strong business relationships with internal partners through business expertise and exceptional support; act as a strategic advisor

  • Meet continuing education standards required for job function, thought leadership and maintenance of actuarial credentials

What You Bring

  • Bachelor's degree or advanced degree (where required)

  • Member of the American Academy of Actuaries

  • Fellow of the Society of Actuaries

  • 7 years of relevant actuarial experience, related experience may be considered.

  • In lieu of an FSA, will consider candidates who are an Associate of the Society of Actuaries (ASA) and have at least 9 years of relevant actuarial experience.

Bonus Points

  • Deep experience with ACA Risk Adjustment, including HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred

  • Proven expertise in ACA Risk Adjustment transfer forecasting and explanation of results to senior leadership - Highly Preferred

  • Strong understanding of diagnosis coding (ICD-10-CM), provider documentation practices, and their impact on risk adjustment outcomes.

  • Advanced analytical skills to identify risk adjustment leakage, emerging risks, and optimization opportunities across ACA populations

What You'll Get

  • The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.

  • Work-life balance, flexibility, and the autonomy to do great work.

  • Medical, dental, and vision coverage along with numerous health and wellness programs.

  • Parental leave and support plus adoption and surrogacy assistance.

  • Career development programs and tuition reimbursement for continued education.

  • 401k match including an annual company contribution

  • Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$143,616.00 - $229,786.00

Skills

Actuarial Analysis, Actuarial Management, Actuarial Science, Actuarial Services, Affordable Care Act (ACA), Complex Care Management, Financial Reporting and Analysis, Hiring Management, Insurance Industry, Organizational Leadership, Regulatory Compliance

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JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.

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