Strategic Risk Adjustment Consultant for Provider Performance

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

Benefits offered by this job

Comprehensive benefits

Paid time off

401(k) plan and wellness benefits

Job summary

Blue Cross Blue Shield of Massachusetts, Inc. is seeking a Risk Adjustment Provider Performance Consultant to design and execute provider engagement and improvement strategies within our risk adjustment program.

Reporting to the Senior Director of Risk Adjustment and Analytics, you will partner with provider networks, clinic managers, and coding leads to enhance documentation, accuracy of CMS HCC capture, and value-based care outcomes.

Qualifications

• Experience in Medicare Advantage risk adjustment and provider network management.
• Progressive experience in strategic program management and provider engagement.
• Ability to influence clinical leaders and executive stakeholders.
• Strong data interpretation and analytics to inform interventions.
• Deep understanding of value-based care, contracting, and HEDIS metrics.
• Mastery of ICD-10-CM guidelines and CMS HCC methodologies.

Responsibilities

• Direct and independently manage the provider engagement strategy for risk adjustment.
• Lead strategic partnerships with provider groups on documentation and coding practices.
• Work with analytics to identify high-value intervention opportunities and gaps.
• Provide advanced coding support and feedback to clinical partners.
• Align risk adjustment goals with contracts and incentive programs.
• Design and present dashboards tracking engagement, ROI, and performance.
• Translate regulatory changes into operational plans for leadership and partners.
• Own multi-year provider-facing risk adjustment initiatives from planning to execution.

Skills

Executive presence

Analytics acumen

Strategic leadership

Cross-functional influence

Regulatory knowledge

Communication & presentation

Education

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

7+ years of experience in lieu of a Bachelor's Degree

Job description

Blue Cross Blue Shield of Massachusetts, Inc. is seeking a Risk Adjustment Provider Performance Consultant to design and execute provider engagement and improvement strategies within our risk adjustment program.

Reporting to the Senior Director of Risk Adjustment and Analytics, you will partner with provider networks, clinic managers, and coding leads to enhance documentation, accuracy of CMS HCC capture, and value-based care outcomes.