Senior Risk Adjustment Coder – Government Programs
Capital Blue Cross
Salary
💰 $21 - $23 per year
Job Level
Mid-LevelSenior
About the role
- Conduct meaningful outreach, provide education, and drive member enrollment
- In partnership with the member, create a Service Plan to guide engagement based on member diagnoses, results of screenings, as well as care gaps
- Build measurable goals for members to develop skills and/or strategies for managing challenges and triggers to reduce hospital admissions/readmissions and use of the ER, and record outcomes
- Coordinate community resources for each member to support them in achieving their goals as outlined in their Service Plans
- Act as an advocate and liaison between the care team (family, physician, facilities, and/or agencies) and member
- Schedule appointments, build accountability, and follow-up services for members
- Elevate critical incidents and information regarding any quality-of-care concerns
- Report hospital diversions, productivity, and other outcomes weekly
- Prepare and maintain all required records, reports, consents, and members’ diagnostic records
- Participate in a program (IVRP) providing coordinated supportive services to participants who have experienced acts of interpersonal violence
Requirements
- Bachelor’s Degree required in nursing, social work, or other health and human services discipline
- Completion of supervised fieldwork and experience in case management, health, or behavioral health preferred
- Experience as a Certified Case Manager (CCM), Community Health Worker (CHW) or Peer Support Specialist (PSS), or Accredited Case Manager (ACM) preferred
- Knowledge of local resources, social determinants of health, mental health, substance abuse disorders, violence, and social issues is required
- Reliable transportation (employee is required to have reliable transportation)
