Risk Adjustment Coder - Project Analyst

Why should you join the BlueCross BlueShield of South Carolina family of companies? other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. if you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

Responsible for evaluating loss potential for each member. Calculates and assigns risk score via a comprehensive risk analysis approach. Ensures action requests and internal/external issues are addressed in a timely manner.

Location:

This position is a hybrid role, located at 17 Technology Circle, Columbia SC 29203. However, we are open to remote workers for this role.

What You'll Do:

• Completes risk assessment of each member at initial enrollment and on an on-going basis when a material diagnosis or family status change occurs. Review new member documentation to ensure all necessary information has been provided in order to calculate risk score. Evaluate prescription history and request health surveys to be completed as needed. Develop forecasting for next plan year to address each member's potential risk. Record forecasting within system to create risk leveling and to forward as appropriate to Healthcare Services for review.
• Completes action requests and other internal and external requests for information pertinent to members.
• Serves as liaison to district offices, other departments, and agents concerning any issues that may arise
• Completes analysis of Grandfathered group business, large group new business, and alternate funding arrangements.
• Reviews and approves or rejects applications for retroactive requests.

To Qualify For This Position, You'll Need The Following:

• Required Education: Bachelor's in a job related field
• Required Work Experience: 2 years medical risk assessment, risk management, data analysis, or other job related work experience.
• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience.
• Required Skills and Abilities: Strong analytical, decision-making, communications, customer service, and advanced math skills. Excellent organizational skills. Proficient spelling, grammar, and punctuation. Knowledge of mathematical or statistical concepts. Ability to use complex mathematical calculations. Ability to handle confidential or sensitive information with discretion. Extensive knowledge of medical coding and its application.
• Software and Other Tools: Standard office equipment. Knowledge of word processing and spreadsheet software.

We Prefer that You Have The Following:

• Preferred Licenses and Certificates: Certified Medical Coder.

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized Health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National Discounts to movies, theaters, zoos, Theme Parks and more

What We Can Do For You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique. abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.

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