Blue Cross & Blue Shield of Rhode Island · 2 months ago
Risk Adjustment HCC Provider Education
Providence, RI
Full-time
Hybrid
Mid Level
$65K/yr - $97K/yr
3+ years expBlue Cross & Blue Shield of Rhode Island is dedicated to improving the health and well-being of Rhode Islanders. The Risk Adjustment HCC Provider Education role involves coordinating provider education related to Risk Revenue and Quality, developing training materials, and analyzing coding data to enhance quality and efficiency in healthcare practices.
Insurance
Responsibilities
Coordinate with ACOs on common strategies to improve quality, coding, and health equity
Work with the analytics team to set metrics to measure the success of the program and monitor progress of individual providers
Works with the analytics team and ACO leadership to identify providers who would benefit from a provider education program and prioritize engagement
Takes feedback from ACO and internal leadership to focus on areas of educational need and improve process
Stays up-to-date on the latest ICD-10 guidelines, OIG Letters, CMS guidance, and Coding Clinics and is able to relay that information internally and externally
Creates training material to distribute externally to ACOs
Works with the coding education manager to improve accuracy and ensure material has relevance to organizational goals
Provide virtual and/or onsite presentations on chart reviews and various topics related to quality improvement to clinicians, staff, and leadership
Works with the internal and external teams to develop individualized presentations and plans for providers
Ability to analyze risks in documentation, billing, and quality and implement a plan to mitigate those risks through intervention
Utilize analytical thinking to assess coding data and trends
Review basic analytic reports to evaluate coding accuracy and efficiency
Present analytic findings and insights during provider training sessions to inform and improve coding practices
Works with the coding education manager to maintain a schedule of provider education visits to maintain a routine in order to provide timely feedback to clinicians
Execute the development, implementation, and maintenance of departmental policies, procedures, and programs
Perform other duties as assigned
Qualification
Required
CPC and CRC coding certification from AAPC, CCS coding certification from AHIMA
Three to five years of experience in provider education, HCC coding, and care management years provider education experience 3+ years of experience in healthcare
Proven analytic experience using Microsoft Excel, database query capabilities and ability to evaluate data at various levels of detail
Strong and effective decision-making skills
Excellent organizational skills and ability to successfully prioritize multiple tasks Proficiency with Microsoft Suite of products (i.e., Word, Excel, PPT, etc.)
Ability to effectively interact with all levels of the organization
Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner
Proficiency in ICD/10-CM medical coding Advanced analytical skills, with the ability to interpret and synthesize basic data sets
Knowledge of business process improvement techniques and strategies
Negotiation skills
Presentation skills
Ability to effectively navigate ambiguous situations with limited direction
Preferred
Bachelor's degree or an equivalent combination of education and experience
Benefits
Flexible work arrangements that include remote and hybrid opportunities
Paid time off
Tuition reimbursement
Assist with student-loan repayment
Health, dental, and vision insurance
Programs that support your mental health and well-being
Bonuses and investment plans
Additional paid time to volunteer
Company
Blue Cross & Blue Shield of Rhode Island
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), we know that health is more than what happens at the doctor’s office.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Martha Wofford
President and CEO
James Joy
Chief Financial Officer - Retired
Company data provided by crunchbase