Provider Risk & Performance Strategist

Blue Cross and Blue Shield of Massachusetts Inc.; Hingham (MA); On-site; USD 119,000 - 145,000; Full time

Benefits offered by this job

Medical/dental/vision insurance

401(k)

Paid time off

Well-being benefits

Job summary

Blue Cross and Blue Shield of Massachusetts Inc. is seeking a Risk Adjustment Provider Performance Consultant in Hingham to lead the provider engagement strategy for risk adjustment.

You will work with clinic managers, billing leads, and coding supervisors to improve documentation and coding accuracy within CMS HCC guidelines. The role emphasizes cross-functional collaboration, data-driven interventions, and delivering executive-level reporting on ROI and network performance.

Qualifications

• 7+ years of Medicare Advantage risk adjustment, provider network management, provider education, or CDI within a health plan or large provider group.
• 5+ years of progressive experience in strategic program management, matrix leadership, or advanced provider engagement.
• Excellent communication and presentation skills to influence executive stakeholders.
• Deep understanding of value-based care models, provider contracting, and how risk adjustment intersects with HEDIS/Quality metrics.

Responsibilities

• Direct and independently manage the overarching provider engagement strategy for risk adjustment.
• Define strategic objectives, core workflows, and KPIs for network-wide provider outreach and engagement.
• Coordinate with Provider Contracting, Health and Medical Management, and Quality teams to integrate risk adjustment goals into contracts and incentive programs.
• Interpret complex provider performance data with Analytics to identify high-value intervention opportunities and documentation gaps.
• Provide advanced coding support and feedback on cases to clinical partners ensuring CMS HCC and ICD-10-CM alignment.
• Develop executive dashboards tracking engagement metrics, ROI of interventions, and overall network performance against targets.

Skills

Executive presence

Analytics acumen

Strategic integration

Technical knowledge

Education

Bachelor's degree in Healthcare Administration, Business, Nursing, Health Information Management, or related field

Tools

ICD-10-CM

CMS HCC methodologies

Job description

Blue Cross and Blue Shield of Massachusetts Inc. is seeking a Risk Adjustment Provider Performance Consultant in Hingham to lead the provider engagement strategy for risk adjustment.

You will work with clinic managers, billing leads, and coding supervisors to improve documentation and coding accuracy within CMS HCC guidelines. The role emphasizes cross-functional collaboration, data-driven interventions, and delivering executive-level reporting on ROI and network performance.