This job requires an experienced, detail-oriented, and highly analytical person to lead, manage, and oversee risk adjustment programs, effectively understanding and implementing vendor programs and ensuring contract SLAs and deliverables are met.
Location preference is for a hybrid work schedule (onsite and work from home), with potential for fully remote work within a mutually acceptable location.
Candidates should have at least 5 years of medical coding, program management, or health industry experience.
Education required is a Bachelor’s Degree or equivalent work experience (two years’ relevant work experience equals one year of college).
Preferred certifications include Certified Professional Coder (CPC) and Certified Risk Coder (CRC).
Additional preferences include local presence in Idaho, healthcare industry experience, and business continuity certifications (CBCP, MBCP, BCCE, etc.).
Responsibilities include monitoring and analyzing program performance metrics to improve accuracy of risk programs, staying current with industry and governmental regulations related to risk adjustment and healthcare compliance, developing educational materials for internal and external stakeholders, identifying risk reduction opportunities during audits, collaborating closely with Legal and Compliance departments, supporting audits to ensure accurate coding and reporting of chronic health conditions, innovating and optimizing risk adjustment processes, and serving as a risk adjustment coding subject matter expert.
The role requires thorough documentation for audit purposes and participation in industry conferences and meetings.
Collaboration spans multiple internal departments and external vendors to ensure compliant, timely processes and data integrity.
The compensation range is estimated between $86,650 and $129,974 annually, with eligibility for an annual incentive bonus based on company and individual performance.
Benefits include paid time off, paid holidays, community service and self-care days, comprehensive medical/dental/vision/pharmacy insurance, 401(k) matching, life insurance, disability insurance, education reimbursement, employee assistance program, adoption assistance, and paid family leave.
Reasonable accommodations are available for individuals with disabilities.
Blue Cross of Idaho is an Equal Opportunity Employer committed to diversity and non-discrimination.
- Minimum of 5 years' experience in medical coding, program management, or a health industry role
- Bachelor's Degree or equivalent experience
- Preferred certifications: Certified Professional Coder (CPC), Certified Risk Coder (CRC)
- Preferred: Business Continuity Certified Professional (CBCP), Master Business Continuity Professional (MBCP), or Business Continuity Certified Expert (BCCE)
- Strong knowledge of risk adjustment programs, healthcare compliance, coding accuracy, and governmental regulations
- Ability to develop training materials and educational programs for diverse stakeholders
- Experience with audit processes related to risk adjustment coding
- Excellent analytical and communication skills
- Ability to collaborate across multiple departments and external partners
- Paid time off, paid holidays, community service, and self-care days
- Comprehensive medical, dental, vision, and pharmacy insurance
- 401(k) matching plus non-contributory plan
- Life insurance coverage
- Short and long term disability insurance
- Education reimbursement program
- Employee Assistance Program (EAP)
- Adoption assistance program
- Paid family leave program
- Reasonable accommodations for disabilities
Location
Idaho, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$86,650 - $129,974
Remote work allowed
Yes
Posted
1 month ago