Blue Cross Blue Shield of Minnesota
Risk Adjustment QA Consultant
Blue Cross Blue Shield of Minnesota, Saint Paul, Minnesota, United States, 55130
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Risk Adjustment QA Consultant
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Risk Adjustment QA Consultant
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Blue Cross and Blue Shield of Minnesota 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.
The Impact You Will Have
As a Risk Adjustment Quality Assurance (QA) Consultant at BCBSMN, youll play a critical role in ensuring the accuracy, completeness, and compliance of risk adjustment coding across both internal teams and external partners. Your work will help uphold the highest standards in documentation and coding practicesprotecting against fraud, waste, and abuse. In this influential role, youll design and implement QA strategies, educate stakeholders on the impact of their work, and use performance metrics to proactively identify and resolve issuesmaking a measurable difference in the quality and integrity of our healthcare data.
Your Responsibilities
Ensure accuracy and compliance of risk adjustment coding, including the appropriate coding of diagnoses and documentation of patient conditions. Primary support to any HHS and CMS RADV audits, including retrieval and coding of targeted medical records. Design and implement QA programs to improve coding accuracy, reduce errors, and prevent fraud. Collaborate with Provider Network, Clinical and Care Management teams to align risk adjustment initiatives with population health, care coordination, and quality improvement programs. Educate internal and external stakeholders, including coders and clinical staff, on proper coding practices and compliance requirements. Manage medical coding metrics, performance improvement opportunities, and evaluation of in-home assessments, chart reviews, and point-of-care programs. Conduct audits of coding practices, identifying areas for improvement, and developing and implementing corrective action plans. Assess outsourced coding vendors to ensure performance, compliance and provide feedback. Stay abreast of changes in coding guidelines, regulations, and risk adjustment methodologies.
Required Skills And Experience
5+ years of relevant professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered. Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment. Certified Risk Adjustment Coder (CRC) certification In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), healthcare compliance, and billing practices. Proficiency in Excel and PowerPoint. Excellent writing skills. Excellent presentation skills. High school diploma (or equivalency) and legal authorization to work in the U.S.
Preferred Skills And Experience
Bachelors degree Experience in provider office medical coding, claims auditing, or specialty clinics. Certifications such as CPMA, RHIT, RHIA, CCA, CCS. Expertise in CMS-HCC, and HHS-HCC Risk Adjustment models.
Compensation And Benefits
Pay Range:
$88,600.00 - $117,400.00 - $146,200.00 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.
Role Designation
Hybrid
Anchored in Connection
Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days a weekone designated anchor day with your team, and one day of your choosing. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.
Equal Employment Opportunity Statement
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 Affirmative 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: talent.acquisition@bluecrossmn.com.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
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Risk Adjustment QA Consultant
role at
Blue Cross and Blue Shield of Minnesota 2 days ago Be among the first 25 applicants Join to apply for the
Risk Adjustment QA Consultant
role at
Blue Cross and Blue Shield of Minnesota 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.
The Impact You Will Have
As a Risk Adjustment Quality Assurance (QA) Consultant at BCBSMN, youll play a critical role in ensuring the accuracy, completeness, and compliance of risk adjustment coding across both internal teams and external partners. Your work will help uphold the highest standards in documentation and coding practicesprotecting against fraud, waste, and abuse. In this influential role, youll design and implement QA strategies, educate stakeholders on the impact of their work, and use performance metrics to proactively identify and resolve issuesmaking a measurable difference in the quality and integrity of our healthcare data.
Your Responsibilities
Ensure accuracy and compliance of risk adjustment coding, including the appropriate coding of diagnoses and documentation of patient conditions. Primary support to any HHS and CMS RADV audits, including retrieval and coding of targeted medical records. Design and implement QA programs to improve coding accuracy, reduce errors, and prevent fraud. Collaborate with Provider Network, Clinical and Care Management teams to align risk adjustment initiatives with population health, care coordination, and quality improvement programs. Educate internal and external stakeholders, including coders and clinical staff, on proper coding practices and compliance requirements. Manage medical coding metrics, performance improvement opportunities, and evaluation of in-home assessments, chart reviews, and point-of-care programs. Conduct audits of coding practices, identifying areas for improvement, and developing and implementing corrective action plans. Assess outsourced coding vendors to ensure performance, compliance and provide feedback. Stay abreast of changes in coding guidelines, regulations, and risk adjustment methodologies.
Required Skills And Experience
5+ years of relevant professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered. Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment. Certified Risk Adjustment Coder (CRC) certification In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), healthcare compliance, and billing practices. Proficiency in Excel and PowerPoint. Excellent writing skills. Excellent presentation skills. High school diploma (or equivalency) and legal authorization to work in the U.S.
Preferred Skills And Experience
Bachelors degree Experience in provider office medical coding, claims auditing, or specialty clinics. Certifications such as CPMA, RHIT, RHIA, CCA, CCS. Expertise in CMS-HCC, and HHS-HCC Risk Adjustment models.
Compensation And Benefits
Pay Range:
$88,600.00 - $117,400.00 - $146,200.00 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.
Role Designation
Hybrid
Anchored in Connection
Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days a weekone designated anchor day with your team, and one day of your choosing. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.
Equal Employment Opportunity Statement
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 Affirmative 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: talent.acquisition@bluecrossmn.com.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Seniority level
Seniority level
Mid-Senior level Employment type
Employment type
Full-time Job function
Job function
Quality Assurance Industries
Insurance Referrals increase your chances of interviewing at Blue Cross and Blue Shield of Minnesota by 2x Get notified about new Quality Assurance Consultant jobs in
Eagan, MN . Minneapolis, MN $120,000.00-$130,000.00 6 days ago St Louis Park, MN $88,000.00-$115,000.00 2 weeks ago Cottage Grove, MN $95,000.00-$120,000.00 2 weeks ago Food Safety and Quality Assurance Manager
Branch Operations Quality Assurance Analyst
Minneapolis, MN $66,192.04-$95,000.00 1 week ago DCT Revenue Cycle Quality Assurance Analyst / Management Analyst 4
Quality Assurance Specialist - Healthcare Payer Industry
Eagan, MN $60,000.00-$70,000.00 1 week ago Senior Quality Engineer (Senior Product Assurance Engineer)
Plymouth, MN $110,000.00-$120,000.00 1 week ago Assurance Manager, Quality Management - IS Assurance
Minneapolis, MN $100,000.00-$150,000.00 6 days ago Food Safety and Quality Assurance Manager
Principal Design Assurance & Quality Engineer
Eden Prairie, MN $125,000.00-$150,000.00 3 weeks ago Senior Manager, Corporate Quality Assurance - Animal Nutrition
Eden Prairie, MN $85,000.00-$120,000.00 2 weeks ago Minneapolis, MN $91,350.00-$193,440.00 3 days ago Quality Assurance Specialist (Medical Report Reviewer)
Minneapolis, MN $60,000.00-$75,000.00 1 month ago Sr. Quality Assurance Specialist for Service Enablement
Plymouth, MN $109,000.00-$168,000.00 2 days ago Edina, MN $73,080.00-$89,320.00 1 month ago Eagan, MN $75,000.00-$90,000.00 6 days ago Minneapolis, MN $70,000.00-$150,000.00 4 days ago Minneapolis, MN $118,300.00-$144,500.00 4 days ago IT Advanced Quality Analyst/Tester - ITS4
Design Quality Assurance Engineer III - Watchman
Maple Grove, MN $76,000.00-$144,400.00 2 days ago Fridley, MN $80,000.00-$92,000.00 3 weeks ago Quality Assurance Automation Engineer 1 - Enterprise Network Performance and Cybersecurity Analytics Platform
Manager, Quality Assurance Engineer AI/ML
Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr