Quality & Risk Adjustment Provider Consultant

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'll Have


In this role, you will play a key element in Blue Cross’ support for providers with value-based agreements. You will review provider-specific data and identifies actionable opportunities for providers to improve their Quality (HEDIS/Stars) and Coding Accuracy/Risk Adjustment performance. In this role you will lead face-to-face meetings with leaders in provider care systems and will be responsible for developing and driving improvement via provider-specific action plans. As a consultant, you are an in-house subject matter experts on coding accuracy and Quality programs such as including HEDIS and Stars.



What You'll Do

• Identifies opportunities for value-based provider groups to improve performance on quality (Stars & HEDIS) and coding accuracy/Risk Adjustment.
• Develop and drive provider-specific action plans to improve Quality and Coding Accuracy performance improvement.
• Facilitates regular discussions with provider group counterparts including reviewing relevant performance data and progress on action plan.
• Consult with providers on best practices to improve performance across Quality and Coding Accuracy measures.
• Develops provider-facing materials on performance and opportunities.




How You'll Do It

• Performs additional responsibilities consistent with the scope and level of the role, as assigned.




Required Skills & Experience

• 7+ years of related process improvement/quality management professional experience.
• Bachelor’s degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.
• Certified Risk Adjustment Coder (CRC via AAPC) within one year of hire.

Preferred Skills & Experience

• Master's degree in related field.
• Ability to translate complex information into actionable messaging, actively listen to diverse perspectives, and drive alignment across cross-functional priorities.
• Ability to analyze complex challenges, evaluate tradeoffs, and collaborate with stakeholders to reach effective, lasting solutions.
• Ability to effectively organize work, balance shifting priorities, and manage time across multiple workstreams to meet commitments.
• Healthcare or related industry experience.
• Medical coding and/or electronic medical record experience.
• Experience in continuous improvement, project management, operational development, performance measurement, change management, or similar role.
• Proven ability to define problems, interpret and analyze data, establish facts, draw valid conclusions, and design measures for processes.
• Detail orientation, with the ability to compare clinical practices against standards and best practices, evaluating compliance, recommending improvement strategies, and producing accurate documentation.
• Experience with Lean, Six Sigma or other Continuous Improvement methodologies.
• Ability to mentor or coach others along with presentation and facilitation skills with the ability to build and maintain effective relationships.




Licensure/Certifications


Required:
Certified Risk Adjustment Coder (CRC via AAPC) within one year of hire.



Role Designation


Hybrid



Role designation definition:

• Teleworking is working full time remote.
• Hybrid is a minimum of 2 days onsite.
• Onsite is full-time onsite.

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 each week – most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.




Compensation and Benefits


$90,800.00 - $120,300.00 - $149,800.00 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.




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: [email protected].

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Physical requirements.