Strategic Provider Performance & Risk Adjustment Consultant

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

Benefits offered by this job

Paid time off

Medical/dental/vision insurance

401(k)

Job summary

Blue Cross Blue Shield of Massachusetts is seeking a Risk Adjustment Provider Performance Consultant to design and execute provider engagement and improvement initiatives. This high-impact role bridges clinical documentation, data analytics, and network strategy under the Senior Director of Risk Adjustment and Analytics.

You will lead cross-functional engagement with provider clinic managers, billing leads, and coding supervisors to drive targeted documentation improvements that align with CMS

Qualifications

• 7+ years of Medicare Advantage risk adjustment, provider network management, or CDI experience.
• 5+ years of strategic program management and cross-functional leadership.
• Executive presence with the ability to influence senior stakeholders.

Responsibilities

• Lead provider engagement strategy and define KPIs for outreach and performance.
• Partner with analytics to identify high-value intervention opportunities.
• Provide advanced coding support and feedback on complex cases.
• Align risk adjustment goals with value-based care contracts and incentives.
• Create executive dashboards tracking ROI and network performance.

Education

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

Job description

Blue Cross Blue Shield of Massachusetts is seeking a Risk Adjustment Provider Performance Consultant to design and execute provider engagement and improvement initiatives. This high-impact role bridges clinical documentation, data analytics, and network strategy under the Senior Director of Risk Adjustment and Analytics.

You will lead cross-functional engagement with provider clinic managers, billing leads, and coding supervisors to drive targeted documentation improvements that align with CMS