Embedded Quality, Risk Adjustment and Medical Coding Specialist (Hybrid)
Baltimore, MD
Employer: | CareFirst BlueCross BlueShield |
Category: |
Health Care
Management |
Job Type: | Full Time |
Description | |
Resp & Qualifications PURPOSE: We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. Acts as an internal population health expert to engage members to drive improvement in NCQA HEDIS measure performance. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and all chronic conditions are captured at the highest level of specificity to ensure Risk Adjustment Revenue is accurate and reflective of true managed care needs. Utilizes extensive HEDIS and coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality outcomes and STARs outcomes while not compromising payment integrity. Note: We are looking for an experience professional who is willing and able to work onsite with health care system partners in the greater Baltimore metropolitan area as an embedded team member. In addition, the incumbent will be expected to come into a CareFirst location periodically for meetings, trainings, and/or other business-related activities. ESSENTIAL FUNCTIONS:
Education Level: High School Diploma or GED. Licenses/Certifications Upon Hire Required:
Preferred Qualifications:
Salary Range: $53,856 - $106,964 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department Stars Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship #LI-CT1 |