Risk Adjustment Provider Service Advisor - CPC or CRC required

Blue Cross Blue Shield of North Carolina

Blue Cross Blue Shield of North Carolina

North Carolina, USA · Remote
Posted on Monday, May 20, 2024

Job Description

This is a provider facing role. Evaluates and monitors 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'll Do

  • Coordinates and leads Provider facing meetings to achieve excellence in risk adjustment coding.
  • Collaborates with Risk Data Analytics and Value Program partners to deliver performance results to large Provider groups.
  • Develops and presents data-driven presentations to large Provider groups to include plan of action or recommendations when deficiencies are identified.
  • Access various reporting databases to collect and analyze date, develop custom presentations and recommendations.
  • Consults with other internal BCBSNC teams to advise on wellness programs and evaluation.
  • Acts as a day-to-day resource for risk adjustment coding and documentation best practices. Provides guidance with interpretation of coding guidelines to assist the provider and/or their representatives.
  • Supports management decisions on workflow process, quality improvement, goal setting and data driven information-based decision-making. Provides timely feedback to management on provider performance. Acts to facilitate change efforts and promote department, division, and corporate goals.
  • Plan on-site visits to stakeholders to educate on risk adjustment coding.
  • Web Content Management System (WCMS) departmental representative/collaborate with other areas to maintain SOP’s, processes, and procedures.
  • Accepts other duties as assigned to help drive the departmental, division and corporate goals.

What We Like

  • Prior experience in a Provider facing role
  • Experience in Microsoft Office Suite of products (Excel, PowerPoint, Word)
  • Experience telling a story using data

What You'll Bring (Hiring Requirements)

  • Bachelor's degree or advanced degree (where required)
  • 3 years of experience in related field.
  • In lieu of degree, 3+ years of experience in related field
  • Must have a Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) certification

Salary Range

$55,800.00 - $89,300.00