Quality & Risk Adjustment Provider Consultant

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing.

If you are ready to make a difference, join us.

In this role, you will provide support for providers with value-based agreements. You will review provider-specific data and identifies actionable opportunities for providers to improve their Quality (HEDIS/Stars) and Coding Accuracy/Risk Adjustment performance. You will lead face-to-face meetings with leaders in provider care systems and is responsible for developing and driving improvement via provider-specific action plans. In this role, you will be an in-house subject matter expert on coding accuracy and Quality programs such as including HEDIS and Stars.

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Identifies opportunities for value-based provider groups to improve performance on quality (Stars & HEDIS) and coding accuracy/Risk Adjustment. li>

Develop and drive provider-specific action plans to improve Quality and Coding Accuracy performance improvement. li>

Facilitates regular discussions with provider group counterparts including reviewing relevant performance data and progress on action plan. li>

Consult with providers on best practices to improve performance across Quality and Coding Accuracy measures. li>

Develops provider-facing materials on performance and opportunities.

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Performs additional responsibilities consistent with the scope and level of the role, as assigned.

li>7+ years of related medical coding professional experience. li>

Bachelor’s degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

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Master's degree in related field. li>

Ability to translate complex information into actionable messaging, actively listen to diverse perspectives, and drive alignment across cross-functional priorities. li>

Ability to analyze complex challenges, evaluate tradeoffs, and collaborate with stakeholders to reach effective, lasting solutions. li>

Ability to effectively organize work, balance shifting priorities, and manage time across multiple work streams to meet commitments. li>

Ability to maintain relationships with internal and external stakeholders, coding experts, and others. li>

Demonstrated ability to apply critical thinking skills to coding policy interpretation and implementation. li>

Experience in auditing medical records. li>

Strong knowledge of medical terminology, medical coding, and healthcare regulations. li>

Ability to travel (locally and non-locally) as determined by business need.

Required:

Coding Certification - AAPC or AHIMA

Nice to Have:
Certification in Health Care Quality and Manager (CHQM) - Relevant Issuer
Certified Professional in Healthcare Quality (CPHQ) - National Association for Healthcare Quality (NAHQ)
Registered Nurse Lic (RN) - State Nursing Licensing Board

Hybrid

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week – most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Pay Range: $90,800.00 - $ - $ Annual

Pay is based on…