Risk Consultant I

The Risk Consultant I provides education and training for the Risk Adjustment Coding team to ensure coding and clinical documentation accuracy and consistency. Collaborating with the Manager of Risk Adjustment Operations, this position will also develop, evaluate and administer a Quality Review Program by auditing medical records reviewed by the coding team and/or vendors providing coding support to BCBSMA against quality standards, identifying both team or individual educational needs, and delivery of relevant training.

The Risk Consultant I will utilize analytics to identify and target providers for Risk Adjustment training and documentation/coding resources. Ultimately, the Risk Consultant I will provide feedback to coders via webinar, teleconference, or in-person training.

Your Day to Day:

• Develop and administer an ongoing Quality Review Program that seeks to ensure all coders are meeting a 95% accuracy rate while adhering to acceptable coding practices as defined by the ICD-10 CM Official Coding Guidelines.
• Successfully perform consistent coding quality reviews to validate correct coding of both the Risk Adjustment Coding Team as well as vendors providing coding support to BCBSMA.
• Develop and conduct ongoing coding training to include but not limited to ICD-10-CM and Medicare Risk Adjustment coding to new associates and existing staff.
• Develop and maintain coding reference tools for the Risk Adjustment Coding Team.
• Work collaboratively with the risk adjustment analysts to prepare, compile, trend and communicate QA results to identify opportunities for performance improvement and further education.
• Provide feedback to coding staff and Risk Adjustment Management on audit results and provide follow-up training on the coding areas requiring improvement.
• Provide audit feedback and educational training to provider organizations as requested.
• Serve as subject matter expert for Medicare and Commercial RADV audits.
• Attend continuing education classes to maintain coding proficiency and certification requirements.
• Aid with production coding as workload permits.
• Participate in special projects as needed.

What You Bring:

• Associates Degree or higher preferred
• Minimum 5+ years of Coding and Risk Adjustment Audit experience
• Extensive knowledge of ICD-10-CM coding guideline
• AAPC, Certified Professional Coder (CPC) or AHIMA, (CCS) and Certified Risk Coder (CRC) certification

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties.

This position is eligible for the Flex persona.

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.