Risk Consultant I

Blue Cross Blue Shield of Massachusetts•Hingham, MA

About The Position

Ready to help us transform healthcare? Bring your true colors to blue. The Risk Consultant I provides education and training for the Risk Adjustment Coding team to ensure coding and clinical documentation accuracy and consistency. Collaborating with the Manager of Risk Adjustment Operations, this position will also develop, evaluate and administer a Quality Review Program by auditing medical records reviewed by the coding team and/or vendors providing coding support to BCBSMA against quality standards, identifying both team or individual educational needs, and delivery of relevant training. The Risk Consultant I will utilize analytics to identify and target providers for Risk Adjustment training and documentation/coding resources. Ultimately, the Risk Consultant I will provide feedback to coders via webinar, teleconference, or in-person training.

Requirements

Associates Degree or higher preferred
Minimum 5+ years of Coding and Risk Adjustment Audit experience
Extensive knowledge of ICD-10-CM coding guideline
AAPC, Certified Professional Coder (CPC) or AHIMA, (CCS) and Certified Risk Coder (CRC) certification
High school degree or equivalent required unless otherwise noted above

Responsibilities

Develop and administer an ongoing Quality Review Program that seeks to ensure all coders are meeting a 95% accuracy rate while adhering to acceptable coding practices as defined by the ICD-10 CM Official Coding Guidelines.
Successfully perform consistent coding quality reviews to validate correct coding of both the Risk Adjustment Coding Team as well as vendors providing coding support to BCBSMA.
Develop and conduct ongoing coding training to include but not limited to ICD-10-CM and Medicare Risk Adjustment coding to new associates and existing staff.
Develop and maintain coding reference tools for the Risk Adjustment Coding Team.
Work collaboratively with the risk adjustment analysts to prepare, compile, trend and communicate QA results to identify opportunities for performance improvement and further education.
Provide feedback to coding staff and Risk Adjustment Management on audit results and provide follow-up training on the coding areas requiring improvement.
Provide audit feedback and educational training to provider organizations as requested.
Serve as subject matter expert for Medicare and Commercial RADV audits.
Attend continuing education classes to maintain coding proficiency and certification requirements.
Aid with production coding as workload permits.
Participate in special projects as needed.