Medicare Risk Adjustment Coder
BlueCross BlueShield of South Carolina
full-time
Posted on:
Location Type: Hybrid
Location: North Carolina • South Carolina • United States
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About the role
- 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
- Perform Health Plan Employer Data Information Set data collection (HEDIS) and National Committee for Quality Assurance (NCQA) accreditation activities
Requirements
- 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
- Certified professional in Healthcare Quality (CPHQ) or other relevant certifications
- Minimum 2 years of managed care, quality improvement, medical research or clinical experience
- Minimum 2 years working with HEDIS standards and Medicare Advantage
- Must be familiar with clinical terminology and medical records
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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analysismedical record reviewcompliance documentationHEDIS data collectionMedicare Stars data monitoringcorrective action recommendationsquality assuranceclinical terminologymedical researchmanaged care
Certifications
Bachelor's degreeAssociate's degreeCertified professional in Healthcare Quality (CPHQ)nursing certificationpharmacy certificationmedical assistant certification