Vacancy caducado!
Additional Locations:Job DescriptionBlue Cross NC is seeking a Risk Adjustment Management Associate for this provider facing role. You will evaluate and monitor provider performance to achieve excellence in risk adjustment coding. Participates in regular provider meetings and/or calls with other internal BCNC teams for collaboration on Blue Premier success. Provides timely, relevant, accurate, and objective feedback to providers, and the management team which includes a plan of action or recommendations when deficiencies are identified. Acts as technical resource and develops learning solutions that engage the learner and produces desired business goals and objectives.What You Will Do
Develop effective learning solutions based on coding guidelines, coding industry updates and trends, and analysis of audit results.
Interpret Tableau dashboard data and reports on individual and departmental results to include benchmarking and trending.
Act as a day-to-day resource for risk adjustment coding and documentation best practices. Provide guidance with interpretation of coding guidelines to assist the provider and/or their representatives.
Present formal presentations to internal and external audiences at all levels, including senior-level leadership.
Work with management team to support decisions on workflow process, quality improvement, goal setting and data driven information-based decision-making.
Provide timely feedback to management on provider performance. Act to facilitate change efforts and promote department, division, and corporate goals.
Utilize Web Content Management System (WCMS) and collaborate with other areas to maintain SOP’s, processes, and procedures.
Accept other duties as assigned to help drive the departmental, division and corporate goals.
What You Bring
Bachelor's degree or advanced degree (where required)
0-2 years of experience in related field.
In lieu of degree, 3+ years of experience in related field.
Must have ICD-10 coding experience and either hold a Certified Professional Coder (CPC) certification or be able to obtain certification within one year of hire.
Nice To Have (preferred qualifications)
Experience with developing PowerPoint presentations and delivering presentations.
Payer experience; and experience working with Providers.
Comfortable working in a fast-paced environment.
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.Blue Cross NC is a fully taxed, not-for-profit North Carolina company with major operations centers in Durham and Winston-Salem. We employ more than 5,000 people who are passionate about health care, and we serve more than 4.3 million members.Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.E-VerifyOur company uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.Third Party Staffing AgenciesBlue Cross NC does not accept unsolicited resumes from any source other than directly from candidates. For the protection of all parties involved in the recruiting process, resumes will only be accepted from recruiters/agencies if a signed agreement is in place at the inception of the recruiting effort and authorized for a specific position. Unsolicited resumes sent to Blue Cross NC from recruiters/agencies do not constitute any type of relationship between the recruiter/agency and Blue Cross NC and do not obligate Blue Cross NC to pay fees if we hire from those resumes.
Vacancy caducado!