Provider Quality & Risk Optimization Consultant

BCBSM, Inc.; Eagan (MN); Hybrid; USD 91,000 - 150,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

401k

PTO & VPTO

Job summary

Blue Cross and Blue Shield of Minnesota is seeking a seasoned professional to support providers with value-based agreements and improve Quality (HEDIS/Stars) and Coding Accuracy/Risk Adjustment. You will lead meetings with provider care system leaders and develop action plans to drive improvements.

The role requires 7+ years in medical coding, a Bachelor’s degree (or equivalent experience), and travel as needed. The position offers a hybrid work arrangement with competitive benefits.

Qualifications

• 7+ years of related medical coding professional experience.
• Bachelor's degree; in lieu of a degree, an additional two years of relevant experience may be accepted.
• Strong knowledge of medical terminology and healthcare regulations.

Responsibilities

• Identify opportunities for value-based provider groups to improve Stars/HEDIS and coding accuracy.
• Develop and drive provider-specific action plans to improve Quality and Coding Accuracy.
• Facilitate discussions with provider group counterparts reviewing performance data and progress.
• Consult with providers on best practices to improve performance across Quality and Coding measures.

Skills

Medical coding

Healthcare regulations

Data interpretation

Education

Bachelor's degree

Master's degree (preferred)

RN license

Job description

Blue Cross and Blue Shield of Minnesota is seeking a seasoned professional to support providers with value-based agreements and improve Quality (HEDIS/Stars) and Coding Accuracy/Risk Adjustment. You will lead meetings with provider care system leaders and develop action plans to drive improvements.

The role requires 7+ years in medical coding, a Bachelor’s degree (or equivalent experience), and travel as needed. The position offers a hybrid work arrangement with competitive benefits.