Remote Provider Educator & Medicare STAR Coder

Southcarolinablues; South Carolina; Remote; USD 70,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Dental and vision coverage

401k with company match

Life Insurance

Paid Time Off

Education assistance

Service recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is hiring a Provider Educator & Medicare Risk Adjustment Coder to monitor and improve Medicare Stars data. The role involves data collection and chart reviews to support compliance with NCQA/CMS standards, plus data-driven actions to enhance health plan ratings.

The position is fully remote with a 40-hour workweek, Monday–Friday. A Bachelor's degree plus healthcare-related certification is required; CRE/CRC/CPC or equivalent is preferred.

Qualifications

• Bachelor's in a job-related field.
• 4 years of job-related work experience or 2 years with an Associate's degree.
• Professional certification in healthcare quality or CRC/CPC or related certificate.
• Minimum 2 years in managed care, quality improvement, medical research, or clinical work.
• Experience with HEDIS standards, Medicare Advantage, and STAR data.

Responsibilities

• Coordinate HEDIS and Star data collection using analytic, paper, and EMR sources.
• Enter and review Star data per NCQA/CMS specs and ensure data quality.
• Oversee external data sources and vendors involved in data submission.
• Identify improvement opportunities using Stars data and support initiatives.
• Ensure HIPAA compliance and high-quality data handling.

Skills

Independent work

Analytical thinking

Verbal and written communication

HIPAA compliance

Data extraction

Problem solving

Education

Bachelor's in a job-related field

Tools

Tableau

Microsoft Excel

Microsoft Access

Job description

BlueCross BlueShield of South Carolina is hiring a Provider Educator & Medicare Risk Adjustment Coder to monitor and improve Medicare Stars data. The role involves data collection and chart reviews to support compliance with NCQA/CMS standards, plus data-driven actions to enhance health plan ratings.

The position is fully remote with a 40-hour workweek, Monday–Friday. A Bachelor's degree plus healthcare-related certification is required; CRE/CRC/CPC or equivalent is preferred.