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Position Summary

This position does require travel within Massachusetts.

This role will be responsible for representing Blue Cross Blue Shield MA's risk adjustment coding improvement initiatives through engagement with health care providers and non-clinical team members. Collaborates with internal teams to develop various clinical documentation and coding education materials. Engage providers on best practices to enhance health care delivery and health outcomes for BCBSMA members.

Key Responsibilities

-Establish and maintain collaborative relationships with assigned providers / provider offices to improve risk adjustment coding and documentation accuracy and completeness.

-Conduct provider trainings on coding and documentation best practices following Official ICD-10 and BCBSMA Internal Coding Guidelines. This is accomplished by doing virtual training sessions or traveling to individual practices and performing side-by-side education.

-Must be able to develop and maintain compliant provider education content such as webinars, recorded trainings, and written materials to support providers and their staff in coding and documentation initiatives.

-Compile data and present solutions regarding trends or patterns identified in provider coding and documentation practices.

-Review necessary documentation, including medical records, and apply clinical coding expertise to evaluate appropriateness of provider documentation and coding.

-Rely upon independent judgement and decision-making skills at provider sites while conducting provider/staff training and education. Respond to provider inquiries regarding specific medical diagnosis coding issues and on proper coding techniques via in person, written and/or telephonic communication.

Key Qualifications

+ + Working Knowledge of MS Word, Excel, and PowerPoint

• Prior experience teaching/training others on correct coding guidelines and must have the ability to present to large groups of Physicians/Providers.

• Ability to effectively engage, educate and present to clinicians and physicians around documentation concepts

• Ability to work as part of team, meet deliverable deadlines, and collaborate with clinical and non-clinical team members

• Exceptional written and verbal communication skills

• CRC Required with demonstrated knowledge of risk adjustment principals

• CPC in conjunction with CRC preferred

Required Education Level and/or Relevant Experience Level

• BA/BS Degree preferred or equivalent work experience and education.

• Knowledge of ICD-10-CM / PCS, CPT, HCPCS, HCC, and modifier coding and specificity of documentation changes

• 3 years Risk Adjustment Coding/Auditing and experience with direct provider education

• Health Insurance/ managed care industry experience preferred within a provider facing setting

• CRC Certification is required, CPC strongly preferred.

Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

LocationHinghamTime TypeFull time

Salary Range: $84,240.00 - $102,960.00

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that the confidence gap (https://www.theatlantic.com/magazine/archive/2014/05/the-confidence-gap/359815/) and imposter syndrome (https://www.braintreepayments.com/blog/overcoming-imposter-syndrome/) can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community (https://careers.bluecrossma.org/us/en/jointalentcommunity?applyType=JTC) to stay “in the know” on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work (https://careers.bluecrossma.org/us/en/how-we-work) " Page.

Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.

Our Commitment to You

We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.