Quality & Risk Adjustment Provider 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

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You'll Have

In this role, you will provide support for providers with value-based agreements. You will review provider-specific data and identifies actionable opportunities for providers to improve their Quality (HEDIS/Stars) and Coding Accuracy/Risk Adjustment performance. You will lead face-to-face meetings with leaders in provider care systems and is responsible for developing and driving improvement via provider-specific action plans. In this role, you will be an in-house subject matter expert on coding accuracy and Quality programs such as including HEDIS and Stars.

What You'll Do

• Identifies opportunities for value-based provider groups to improve performance on quality (Stars & HEDIS) and coding accuracy/Risk Adjustment.
• Develop and drive provider-specific action plans to improve Quality and Coding Accuracy performance improvement.
• Facilitates regular discussions with provider group counterparts including reviewing relevant performance data and progress on action plan.
• Consult with providers on best practices to improve performance across Quality and Coding Accuracy measures.
• Develops provider-facing materials on performance and opportunities.

How You'll Do It

Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Required Skills & Experience

• 7+ years of related medical coding professional experience.
• Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Preferred Skills & Experience

• Master's degree in related field.
• Ability to translate complex information into actionable messaging, actively listen to diverse perspectives, and drive alignment across cross-functional priorities.
• Ability to analyze complex challenges, evaluate tradeoffs, and collaborate with stakeholders to reach effective, lasting solutions.
• Ability to effectively organize work, balance shifting priorities, and manage time across multiple workstreams to meet commitments.
• Ability to maintain relationships with internal and external stakeholders, coding experts, and others.
• Demonstrated ability to apply critical thinking skills to coding policy interpretation and implementation.
• Experience in auditing medical records.
• Strong knowledge of medical terminology, medical coding, and healthcare regulations.
• Ability to travel (locally and non-locally) as determined by business need.

Licensure/Certifications Required

• Coding Certification - AAPC or AHIMA
• Nice to Have: Certification in Health Care Quality and Manager (CHQM) - Relevant Issuer
• Certified Professional in Healthcare Quality (CPHQ) - National Association for Healthcare Quality (NAHQ)
• Registered Nurse Lic (RN) - State Nursing Licensing Board

Role Designation

Hybrid Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Compensation and Benefits

• $90,800.00 - $120,300.00 - $149,800.00 Annual Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Aff… All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: [e-mail]. Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Physical requirements

Chartered in 1933 as Minnesota's first health plan, this company is one of the most recognized and trusted healthcare brands in the world. It has more members, the largest network of doctors, and more products and services than any other health plan in Minnesota. Headquartered in Eagan, Minnesota.