Blue Cross and Blue Shield of Vermont

Provider Engagement Consultant | Full Time

Category: Health Care/Personal Care

Location: 445 Industrial Lane

Blue Cross and Blue Shield of Vermont is looking for a Provider Engagement Consultant to join our Risk Adjustment team. Our company culture is built on an unwavering focus on our members and giving them the best service possible. We offer a balanced, flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package including medical and dental insurance, vision, 401k, paid time off and holidays, tuition reimbursement and student loan repayment, dependent caregiver benefits, and resources to support your ongoing personal and professional growth and development.

COVID-19: Blue Cross is requiring all employees and covered consultants to be fully vaccinated (including booster if eligible) against COVID-19 and provide proof of vaccination as of January 1, 2022. Those with a medical condition or sincerely held religious belief preventing them from being vaccinated can request an exemption without fear of retaliation or an impact on job candidacy

REMOTE WORK: Blue Cross is transitioning to hybrid workplace by July 2022, where employees within driving distance of our Berlin, VT office will work two days per week in the office with flexibility to work remotely the rest of the week.

 Provider Engagement Consultant Responsibilities:

  • Serves as the primary point of contact, consultative resource and subject matter expert in all aspects of coding and medical record documentation requirements as they apply to Risk Adjustment.
  • Review medical records for coding and documentation accuracy, completeness and specificity.
  • Educate practitioners and office staff, to include the creation of trainings, that relate to Risk Adjustment and Hierarchical Condition Category (HCC) best practices.
  • Audit the coding accuracy of vendors.
  • Prepare and present reports on program activities and performance metrics to internal and external stakeholders.
  • Follow up on internally developed Corrective Action Plans to correct issues found by the federal government for rules and/or regulations infractions related to Affordable Care Act (ACA) or Medicare Advantage (MA) risk adjustment.

 Provider Engagement Consultant Qualifications:

  • Nursing degree or other medical degree strongly preferred.
  • Minimum of two years of clinical/coding practice experience in a provider’s office, hospital setting, or comparable setting required.
  • One of the following certifications required: Certified Documentation Information Specialist (CDIS), Certified Clinical Documentation Specialist (CCDS), Coding Certification Specialist (CCS or CCS-P), Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), with minimum of two years’ experience using certification in the workplace.
  • Experience working with Hierarchical Condition Categories (HCCs) preferred.

 Provider Engagement Consultant Benefits:

  • Health insurance (including vision)
  • Dental coverage (free to employees)
  • Wellness Program
  • 401(k) with employer match + automatic employer contribution
  • Life Insurance
  • Disability Insurance
  • Combined time off (CTO) – 20 days per year + 9 paid holidays
  • Tuition Reimbursement
  • Student Loan Repayment
  • Dependent Caregiver Benefits

*full job description attached to ADP posting


To Apply:

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