Full Time
Blue Shield of Calfornia
Hybrid
Your Role
The Risk Adjustment Compliance Specialist, Principal is responsible for ensuring organizational compliance with laws related to Risk Adjustment across our Marketplace (ACA), Medicaid and Medicare Advantage lines of business. This role involves auditing, monitoring, and evaluating risk adjustment processes, identifying areas of non-compliance, and recommending corrective actions. The Principal collaborates with internal teams and external partners to maintain the integrity of risk adjustment data and supports the development and implementation of compliance programs.
Responsibilities
Your Work
In this role, you will:
Conduct regular audits and reviews of risk adjustment data submissions to ensure compliance with regulatory requirements (e.g., CMS, OIG, HHS).
Monitor changes in risk adjustment guidelines, policies, and regulations, and communicate updates to relevant stakeholders.
Analyze risk adjustment...
