Government Programs Clinical Coordinator, Senior

Blue Cross Blue Shield • Kansas City, MO

58d

About The Position

This role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts, identify gaps in care, and educate providers and offices to ensure they are coding to the highest specificity

Requirements

• Bachelor's Degree in Healthcare, Healthcare Administration, Business or related field
• 10+ years of healthcare industry experience
• 5+ years of provider facing experience
• Strong knowledge of Medicare Advantage and Qualified Health Plans (ACA) including Stars and Risk Adjustment
• Experience in consulting to process improvement with provider groups
• Microsoft Office experience including Excel with exceptional analytical and data representation expertise
• Strong relationship building skills with clinical and non-clinical personnel
• Active certified coding professional through AHIMA or AAPC with at least five years coding experience
• Obtain Certified Risk Coder (CRC) within 1 year of hire

Nice To Haves

• Strong problem-solving skills
• Experience working for a health plan and/or within a provider office
• Registered Nurse and/or medical licensure
• Knowledge base of clinical standards of care, preventive health, and Stars measures
• Experience with network and provider relations/contracting
• Experience retrieving data from EMRs (electronic medical records)

Responsibilities

• Travel across service area to meet with providers to discuss Blue KC tools and incentive programs focused on improving the quality of care for Medicare Advantage & Qualified Health Plan (ACA) Members.
• Establish positive, long-term, consultative relationships with physicians and medical groups.
• Analyze data and monitor provider metrics to identify risk adjustment, HEDIS or educational opportunities for the Medicare Advantage and Qualified Health Plan lines of business.
• Develop educational tools for network providers regarding risk adjustment and HEDIS documentation and coding best practices to facilitate risk adjustment gap closure and improve health outcomes.
• Coordinate and provide ongoing strategic recommendations, training, and coaching to provider groups on program implementation and barrier resolution.
• Provide training on Stars measures, risk adjustment coding practices, and Blue KC program administration, use of plan tools, reports, and systems.
• Review clinical data to identify chronic condition management opportunities with provider groups related to risk recapture.
• Facilitate and coordinate formal training program for providers
• Lead and participate in meetings with provider groups to drive continual process improvement and achieve goals.

Benefits

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees