Your Role

The Blue Shield's Risk Adjustment (RA) team plays a crucial role in bringing healthcare into the digital age. The RA team is highly cross-functional, with each team member deeply skilled in both business-operations and data-analytics; this enables us to deliver industry-leading results. The RA team is looking to improve operational coordination with our providers to more effectively retrieve medical records. This role is highly collaborative and requires the ability to understand and coordinate operations across multiple providers and health insurer areas.

The Chart Retrieval, Risk Adjustment Consultant will report to the Manager of Medicare Chart Program. In this role you will play a critical role in expanding Blue Shield's medical records retrieval initiatives, ensuring accuracy and timeliness for both our ACA and Medicare teams.

Your Work

In this role, you will:

• Make recommendations based on understanding the core principles and functionality of decision, descriptive, predictive, and prescriptive analytic methods
• Train lower-level analysts on how to update and apply these advanced analytic techniques
• Drive leadership, guidance, and manage all aspects of a given program, including vendor oversight, internal cross-functional partnerships, tracking performance and measuring results
• Manage data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals
• Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products
• Collaborate with healthcare providers and vendors to efficiently acquire medical records, particularly with non-responsive providers and charts showing as not available in providers' Electronic Medical Records systems
• Collaborate closely with ACA Retrospective Risk Adjustment Team and Medicare Retrospective Risk Adjustment Team to improve medical records retrieval
• Utilize strong communication skills to liaise with internal and external stakeholders
• Maintain a meticulous and organized approach to ensure accurate record retrieval through grouping charts by custodians per rosters and instructions from providers
• Proactively identify and implement improvements to optimize the retrieval process

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 6 years of professional experience
• Requires at least 4 years of Risk Adjustment, medical records retrieval, or a related field
• Requires excellent written and spoken communication skills of technical material to executive leadership and interpersonal skills
• Requires strong organization skills and a keen eye for detail
• Requires the ability to work independently and as part of a team

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

Pay Range:

The pay range for this role is: $ 118800.00 to $ 178200.00 for California.