Risk Adjustment Coder - Project Analyst
About The Position
Why should you join the BlueCross BlueShield of South Carolina family of companies? other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. if you are dedicated to the same philosophy, consider joining our team! Position Purpose: Responsible for evaluating loss potential for each member. Calculates and assigns risk score via a comprehensive risk analysis approach. Ensures action requests and internal/external issues are addressed in a timely manner. Location: This position is a hybrid role, located at 17 Technology Circle, Columbia SC 29203. However, we are open to remote workers for this role.
Requirements
- Required Education: Bachelor's in a job related field
- Required Work Experience: 2 years medical risk assessment, risk management, data analysis, or other job related work experience.
- Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience.
- Required Skills and Abilities: Strong analytical, decision-making, communications, customer service, and advanced math skills.
- Excellent organizational skills.
- Proficient spelling, grammar, and punctuation.
- Knowledge of mathematical or statistical concepts.
- Ability to use complex mathematical calculations.
- Ability to handle confidential or sensitive information with discretion.
- Extensive knowledge of medical coding and its application.
- Software and Other Tools: Standard office equipment.
- Knowledge of word processing and spreadsheet software.
Nice To Haves
- Preferred Licenses and Certificates: Certified Medical Coder.
Responsibilities
- Completes risk assessment of each member at initial enrollment and on an on-going basis when a material diagnosis or family status change occurs.
- Review new member documentation to ensure all necessary information has been provided in order to calculate risk score.
- Evaluate prescription history and request health surveys to be completed as needed.
- Develop forecasting for next plan year to address each member's potential risk.
- Record forecasting within system to create risk leveling and to forward as appropriate to Healthcare Services for review.
- Completes action requests and other internal and external requests for information pertinent to members.
- Serves as liaison to district offices, other departments, and agents concerning any issues that may arise
- Completes analysis of Grandfathered group business, large group new business, and alternate funding arrangements.
- Reviews and approves or rejects applications for retroactive requests.
Benefits
- We offer our employees great benefits and rewards.
- You will be eligible to participate in the benefits the first of the month following 28 days of employment.
- Subsidized Health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National Discounts to movies, theaters, zoos, Theme Parks and more
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
