Value-Based Quality & Risk Advisor

Blue Cross & Blue Shield of Minnesota; Eagan (MN); Hybrid; USD 91,000 - 150,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Life insurance

401k

PTO

Volunteer PTO

And more

Job summary

Blue Cross and Blue Shield of Minnesota is seeking a seasoned professional to support providers with value-based agreements, driving quality (HEDIS/Stars) and coding accuracy. You will lead provider-facing initiatives, review performance data, and develop action plans to improve outcomes.

The role blends in-house expertise on coding accuracy with quality programs, and requires collaboration with provider groups. Hybrid work arrangement and a comprehensive benefits package are offered.

Qualifications

• 7+ years of medical coding experience required.
• Bachelor’s degree required; additional 2 years may substitute.
• Master’s degree preferred.
• Auditing medical records experience preferred.
• Strong knowledge of medical terminology, coding, and healthcare regulations.
• Ability to travel as needed.

Responsibilities

• Identify opportunities to improve Stars and HEDIS quality and coding accuracy.
• Develop provider-specific action plans to improve performance.
• Lead meetings with provider care system leaders.
• Create provider-facing materials on performance.
• Consult with providers on best practices to improve performance.
• Facilitate data reviews and progress on action plans.

Skills

Translate complex information

Active listening

Analytical thinking

Stakeholder collaboration

Time management

Relationship building

Coding policy interpretation

Medical records auditing

Medical terminology & coding

Travel ability

Education

Bachelor’s degree

Master’s degree in related field

Job description

Blue Cross and Blue Shield of Minnesota is seeking a seasoned professional to support providers with value-based agreements, driving quality (HEDIS/Stars) and coding accuracy. You will lead provider-facing initiatives, review performance data, and develop action plans to improve outcomes.

The role blends in-house expertise on coding accuracy with quality programs, and requires collaboration with provider groups. Hybrid work arrangement and a comprehensive benefits package are offered.