[Hiring] Provider Educator & Medicare Risk Adjustment Coder @BlueCross BlueShield of South Carolina

Role Description

We are currently hiring for a Provider Educator & Medicare Risk Adjustment Coder to join BlueCross BlueShield of South Carolina. In this role, you will:

• Monitor and collect Medicare Stars data to improve health plan ratings.
• Conduct specific medical record reviews.
• Analyze findings and make recommendations for corrective actions.
• Prepare formal documentation for compliance with applicable standards/regulations.
• Perform Health Plan Employer Data Information Set data collection (HEDIS) and National Committee for Quality Assurance (NCQA) accreditation activities.

Qualifications

• Bachelor's in a job-related field.
• 4 years job-related work experience or Associate's and 2 years job-related work experience.
• Professional certification in nursing, pharmacy, medical assistant, or other healthcare training, OR Certified professional in Healthcare Quality (CPHQ), Academy for Health Care Management (AHM), Health Information Management (HIM), Certified Risk Adjustment Coder (CRC), or other related certification.

Requirements

• Minimum 2 years of managed care, quality improvement, medical research, or clinical experience.
• Minimum 2 years working with HEDIS standards, quality measures, and Medicare Advantage (can be concurrent).
• Familiarity with clinical terminology and reading paper/electronic medical records.
• Ability to work independently with a detailed focus on paper/electronic medical information and other sources to extract needed data for Medicare Star ratings.
• Understanding and following HEDIS NCQA, HOS, CAHPS, Pharmacy, and Star measure data requirements.
• Maintain HIPAA compliance and quality standards.
• Excellent verbal and written communication, customer service, organizational, presentation, problem-solving, and analytical or critical thinking skills.
• Proficient spelling, grammar, punctuation, and basic business math.
• Ability to handle confidential or sensitive information with discretion.
• Demonstrated ability to identify the need for and implement corrective actions.
• Strong understanding of managed care.

Benefits

• 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.