HCC Coding/Risk Adjustment Provider Educator
About the position 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. 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. Responsibilities • 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. • Identify providers who would benefit from a provider education program and prioritize engagement. • Take feedback from ACO and internal leadership to focus on areas of educational need and improve process. • Stay up-to-date on the latest ICD-10 guidelines, OIG Letters, CMS guidance, and Coding Clinics. • Create training material to distribute externally to ACOs. • Provide virtual and/or onsite presentations on chart reviews and various topics related to quality improvement to clinicians, staff, and leadership. • 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. • Maintain a schedule of provider education visits to provide timely feedback to clinicians. • Execute the development, implementation, and maintenance of departmental policies, procedures, and programs. • Perform other duties as assigned. Requirements • 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. • 3+ years of experience in healthcare. • Proven analytic experience using Microsoft Excel, database query capabilities. • 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. • 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. Nice-to-haves • Bachelor's degree or an equivalent combination of education and experience. Benefits • Hybrid work schedule. • Support for associate well-being and work/life balance. Apply tot his job