Quality & Risk Adjustment Provider Consultant
About The Position
This role is a key element in Blue Cross’ support for providers with value-based agreements. The role reviews provider-specific data and identifies actionable opportunities for providers to improve their Quality and Coding Accuracy performance. The role leads face-to-face meetings with leaders in provider care systems and is responsible for developing and driving improvement via provider-specific action plans. The consultants are in-house subject matter experts on coding accuracy and Quality programs such as including HEDIS and Stars.
Requirements
- 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
- 1+ years of provider-facing or leadership-facing experience
- Knowledge of Health Care Quality measures
- Certified Risk Adjustment Coder (CRC via AAPC) or Certified Professional Coder (CPC via AAPC). If you do not have both the CRC AND CPC, it will be required to obtain both AAPC certifications within the first year in position (CRC within 6 months of hire and CPC within 1 year of hire, if not currently CPC or CCS-P
- Experience successfully balancing multiple priorities or projects at the same time.
- Excellent verbal and written communication skills
- Experience creating professional .ppt slides or other presentation materials.
- High School diploma (or equivalency) and legal authorization to work in the U.S.
Nice To Haves
- Certification in healthcare quality such as Certified Profession in Healthcare Quality (CPHQ) or Certification in Health Care Quality and Manager (CHQM)
- Registered Nurse
Responsibilities
- Identifies opportunities for provider groups to improve performance on quality and coding accuracy.
- Develop and drive provider-specific action plans to improve Quality and Coding Accuracy performance improvement.
- Consult with providers on best practices to improve performance across Quality and Coding Accuracy measures
- Facilitates monthly discussions with provider group counterparts including reviewing relevant performance data and progress on action plan
- Develops provider-facing materials on performance and opportunities
- Serve as subject matter expert for providers regarding Quality measures and coding-accuracy performance.
Benefits
- Medical, dental, and vision insurance
- Life insurance
- 401k
- Paid Time Off (PTO)
- Volunteer Paid Time Off (VPTO)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
1,001-5,000 employees
