Blue Cross Blue Shield of Massachusetts · 12 hours ago
Risk Consultant I
Hingham
Full-time
Onsite
Mid, Senior Level
$90K/yr - $110K/yr
5+ years expBlue Cross Blue Shield of Massachusetts is dedicated to transforming healthcare, and they are seeking a Risk Consultant I to provide education and training for the Risk Adjustment Coding team. This role involves developing and administering a Quality Review Program, conducting coding training, and utilizing analytics to enhance coding accuracy and documentation.
AssociationCommunitiesHealth InsuranceInsuranceMedicalNon Profit
Responsibilities
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
Qualification
Required
High school degree or equivalent required
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
Preferred
Associates Degree or higher preferred
Benefits
Paid time off
Medical/dental/vision insurance
401(k)
A suite of well-being benefits to eligible employees
Company
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of Massachusetts is a state licensed private health insurance company
1001-5000 employees
H1B Sponsorship
Blue Cross Blue Shield of Massachusetts has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
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Trends of Total Sponsorships
2025 (11)
2024 (21)
2023 (8)
2021 (2)
2020 (6)
Funding
Current Stage
Late StageLeadership Team
Sarah Iselin
President and Chief Executive Officer
Sophie Clarke
Chief Strategy Officer
Recent News
2025-12-09
2025-11-24
Boston Globe
2025-11-14
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