Remote Provider Educator & Medicare Risk Adjustment Coder

BlueCross and BlueShield of South Carolina; United States; Remote; USD 80,000 - 110,000; Full time

Job summary

BlueCross BlueShield of South Carolina is seeking a Provider Educator & Medicare Risk Adjustment Coder to monitor and collect Medicare Stars data, perform records reviews, analyze findings, and develop corrective actions. The role also includes data collection for HEDIS and NCQA accreditation activities.

The candidate will work in a full-time, remote setting with occasional on-site trainings. Sponsorship is not available for this position.

Qualifications

• Bachelor's degree in a job-related field.
• Minimum 2 years of managed care, quality improvement, medical research or clinical experience.
• Minimum 2 years working with HEDIS standards, quality measures, and Medicare Advantage.

Responsibilities

• Coordinate HEDIS and Star measure data collection using analytic resources and medical records.
• Conduct data entry and review of Star measure data per NCQA & CMS specs.
• Maintain oversight of external data sources and vendors; monitor data quality.
• Identify improvement opportunities and support Stars program initiatives.

Skills

Attention to detail

Analytical thinking

Communication

Independent work

Healthcare terminology

Education

Bachelor's degree

4 years related work experience or Associate's + 2 years

Job description

BlueCross BlueShield of South Carolina is seeking a Provider Educator & Medicare Risk Adjustment Coder to monitor and collect Medicare Stars data, perform records reviews, analyze findings, and develop corrective actions. The role also includes data collection for HEDIS and NCQA accreditation activities.

The candidate will work in a full-time, remote setting with occasional on-site trainings. Sponsorship is not available for this position.