|Employer:||Premera Blue Cross
|Location:|| Mountlake Terrace 98043, WA, US
Join Our Team: Do Meaningful Work and Improve People’s Lives
Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.
To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!
As a Risk Adjustment Coding Provider Consultant, you will be responsible for developing and executing a risk adjustment (RA) data-sharing, training, and consulting program that will lead to improved provider documentation and coding behavior across our WA and AK network. You will analyze documentation and coding trends as well as develop strategies and tactics to improve risk adjustment outcomes, including collaborating with large provider systems on custom documentation and coding reviews executed by risk adjustment Premera’s coding team. Additionally, you will develop and deploy customized training and engagement methods, including web trainings, educational visual aids, and training curricula to support the RA provider performance improvement strategy.
What you’ll do:
Develop and execute strategies to influence provider behavior in alignment with risk adjustment objectives and in coordination with the Provider Clinical Consultant Program. Develop actionable data and recommendations for adjusting workflow processes to improve diagnostic risk capture at the point of care and improve accuracy of documentation and claims data.
Consult with and educate providers on coding and documentation practices in a collaborative manner and with attention to adult learning concepts. Clearly articulate the methods and desired outcomes associated with the Risk Adjustment Program.
Function independently or partner with Provider Clinical Consultants, travel to meet with providers to conduct education sessions and/or to discuss risk adjustment coding tools and programs.
Analyze coding results to develop and maintain training material, program documentation, and tools for providers. Analyze and synthesize documentation and coding trends to inform program and provider specific goals.
Use effective presentation and facilitation techniques to support delivery of training initiatives and customized training developed for diverse provider audiences (clinicians, coders, support staff, practice managers, etc.).
Review medical records and submitted claims, summarize pertinent information, and identify gaps and opportunities for improvement.
Maintain current knowledge of coding applications for International Classification of Disease (ICD) and other applicable coding systems that apply to medical documentation and claims.
Consult with Medical Directors, Provider Network Management, Healthcare Economics, and other key stakeholders to support on-going development of risk adjustment coding initiatives.
What You’ll Bring:
Education and experience equivalent to a Bachelor’s Degree and/or five (5) years of relevant experience.
Certified Risk Adjustment Coder (CRC) or relevant professional coding certification. In absence of CRC certification, the incumbent must earn a CRC within six (6) months of hire.
Experience with the risk adjustment models like the Center for Medicare & Medicaid Services Hierarchical Condition Categories (CMS-HCC) and/or the Department of Health and Human Services Hierarchical Condition Categories (HHS-HCC)
Experience creating and/or delivering training programs based on adult learning theory.
Ability to assimilate data and information, conduct analyses, identify trends, and make recommendations for clinical or administrative process improvement.
Proven ability to effectively communicate with a variety of audiences both verbally and in writing; Excellent presentation skills, including an ability to influence behavior.
Proven interpersonal skills with the ability to foster positive relationships.
Ability to travel, including occasional overnight travel as required; travel to Alaska would be limited to once or less per year.
What we offer
Medical, vision and dental coverage
Life and disability insurance
Retirement programs (401K employer match and pension plan)
Wellness incentives, onsite services, a discount program and more
Tuition assistance for undergraduate and graduate degrees
Generous Paid Time Off to reenergize
Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.