Quality & Risk Adjustment Provider Consultant

About Blue Cross and Blue Shield of Minnesota

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.

This role is a key element in Blue Cross’s support for providers with value-based agreements. The role reviews provider-specific data and identifies actionable opportunities for providers to improve their Quality and Coding Accuracy performance. The role leads face-to-face meetings with leaders in provider care systems and is responsible for developing and driving improvement via provider-specific action plans. The consultants are in-house subject matter experts on coding accuracy and Quality programs such as including HEDIS and Stars.

As part of a Blue Cross provider-performance consultation team, this role

• Identifies opportunities for provider groups to improve performance on quality and coding accuracy.
• Develop and drive provider-specific action plans to improve Quality and Coding Accuracy performance improvement.
• Consult with providers on best practices to improve performance across Quality and Coding Accuracy measures.
• Facilitates monthly discussions with provider group counterparts including reviewing relevant performance data and progress on action plan.
• Develops provider-facing materials on performance and opportunities.
• Serve as subject matter expert for providers regarding Quality measures and coding-accuracy performance.

• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• 1+ years of provider-facing or leadership-facing experience.
• Knowledge of Health Care Quality measures.
• Certified Risk Adjustment Coder (CRC via AAPC) or Certified Professional Coder (CPC via AAPC). If you do not have both the CRC AND CPC, it will be required to obtain both AAPC certifications within the first year in position (CRC within 6 months of hire and CPC within 1 year of hire, if not currently CPC or CCS-P).
• Experience successfully balancing multiple priorities or projects at the same time.
• Excellent verbal and written communication skills.
• Experience creating professional .ppt slides or other presentation materials.
• High School diploma (or equivalency) and legal authorization to work in the U.S.

• Certification in healthcare quality such as Certified Profession in Healthcare Quality (CPHQ) or Certification in Health Care Quality and Manager (CHQM).
• Registered Nurse.

Pay Range: $88,600.00 - $ - $ Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

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.

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affidative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talen

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.