HCC Coding/Risk Adjustment Provider Educator

Schedule: Hybrid

Compensation: $64,600 - $96,800

Jump into the new world of health insurance:

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.

Join others who know diversity is strength:

We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.

Why this job matters:

Perform daily operations of provider education as it pertains to Risk Revenue and Quality department. Execute the development, implementation, and maintenance of departmental policies, procedures, and programs.

What you will do:

• 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.

What you need to succeed:

• 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

The extras:

• Bachelor's degree or an equivalent combination of education and experience