Job Information
BlueCross BlueShield of North Carolina Risk Adjustment Provider Service Provider - CPC or CRC required in Remote, North Carolina
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
About Us
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 company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.
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.
Authorization to Work in the United States
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For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:
Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
Much more than a paycheck
The total value of working at Blue Cross NC goes far beyond your paycheck. We offer benefits and perks (https://careers.bluecrossnc.com/global/en/benefits) that help you thrive, such as competitive health benefits, bonus plans based on performance, 401(k) with employer match, paid time off (plus two well-being days), and a variety of career development and wellness programs.