Clinical Risk Adjustment Strategist
3 days ago
At Blue Shield of California, we are seeking a skilled Clinical Risk Adjustment Strategist to join our team. In this role, you will have the opportunity to make a significant impact on the success of our Risk Adjustment Program.
Company OverviewOur company is a leading health insurance provider in California, dedicated to delivering high-quality care to our members. We are committed to innovation and excellence in everything we do, from our customer service to our clinical programs.
The Risk Adjustment Consultant will work closely with operational and clinical leaders to improve recapture rates, understand clinical suspects, and monitor documentation and coding accuracy. They will also implement Blue Shield Programs that ensure diagnoses are coded according to CMS and risk adjustment guidelines.
This role requires a deep understanding of clinical metrics, claims/encounters, and risk adjustment analytics. The ideal candidate has strong customer service, project management, organizational, and analytical skills, is a self-starter, and pays high attention to detail.
We are looking for someone with at least 6 years of professional experience and a bachelor's degree. A master's degree is preferred. You should have knowledge of ICD-10 codes, Risk Adjustment models, Medicare Quality/Stars, analytics/finance, provider contracting, provider relations, medical management, and/or provider network management areas of a healthcare-related company.
Key Responsibilities:
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