$143.62K - $229.79K/yr
Deep experience with ACA Risk Adjustment , including HHS-HCC model methodology, risk score ... Strong understanding of diagnosis coding (ICD-10-CM) , provider documentation practices, and their ...
$143.62K - $229.79K/yr
Deep experience with ACA Risk Adjustment , including HHS-HCC model methodology, risk score ... Strong understanding of diagnosis coding (ICD-10-CM) , provider documentation practices, and their ...
Louisville, KY · On-site +1
$33.50 - $45/hr
... coding staff and physicians to identify diagnoses impacting severity of illness, risk adjustment ... Strong understanding of coding classification systems including ICD-10-CM, MS-DRG, APR-DRG, and HCC ...
Louisville, KY · On-site +1
$33.50 - $45/hr
... coding staff and physicians to identify diagnoses impacting severity of illness, risk adjustment ... Strong understanding of coding classification systems including ICD-10-CM, MS-DRG, APR-DRG, and HCC ...
Louisville, KY · Remote
$15.25 - $19/hr
... Risk Adjustment Representative 2 conducts quality assurance review of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other ...
Louisville, KY · Remote
$15.25 - $19/hr
... Risk Adjustment Representative 2 conducts quality assurance review of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other ...
... risk and evaluate efficiency and effectiveness. In addition to auditing, you will have an ... Knows and follows the rules, regulations, and the Code of Professional Conduct of the AICPA, the ...
... risk and evaluate efficiency and effectiveness. In addition to auditing, you will have an ... Knows and follows the rules, regulations, and the Code of Professional Conduct of the AICPA, the ...
$15.25 - $19.50/hr
... risk and evaluate efficiency and effectiveness. In addition to auditing, you will have an ... Knows and follows the rules, regulations, and the Code of Professional Conduct of the AICPA, the ...
$15.25 - $19.50/hr
... risk and evaluate efficiency and effectiveness. In addition to auditing, you will have an ... Knows and follows the rules, regulations, and the Code of Professional Conduct of the AICPA, the ...
Ashland, KY · On-site +1
Volunteer work and internships for academic credit are not counted. Certifications & Licensures ... Coder (CPC), Certified Professional Coder Apprentice (CPC-A), Certified Coding Associate (CCA ...
Ashland, KY · On-site +1
Volunteer work and internships for academic credit are not counted. Certifications & Licensures ... Coder (CPC), Certified Professional Coder Apprentice (CPC-A), Certified Coding Associate (CCA ...
Volunteer work and internships for academic credit are not counted. Certifications & Licensures: RHIA Certification, CPMA, CCDS, Certified Coding Specialist (CCS) or Certified Professional Coder (CPC ...
Volunteer work and internships for academic credit are not counted. Certifications & Licensures: RHIA Certification, CPMA, CCDS, Certified Coding Specialist (CCS) or Certified Professional Coder (CPC ...
Ashland, KY · On-site +1
$15.25 - $16.50/hr
Coordinates cross-functional problem solving with coding, clinical, and payer partners to support ... Volunteer work and internships for academic credit are not counted. Certifications & Licensures: N ...
Ashland, KY · On-site +1
$15.25 - $16.50/hr
Coordinates cross-functional problem solving with coding, clinical, and payer partners to support ... Volunteer work and internships for academic credit are not counted. Certifications & Licensures: N ...
Volunteer work and internships for academic credit are not counted. Certifications & Licensures: RHIA Certification, CPMA, CCDS, Certified Coding Specialist (CCS) or Certified Professional Coder (CPC ...
Volunteer work and internships for academic credit are not counted. Certifications & Licensures: RHIA Certification, CPMA, CCDS, Certified Coding Specialist (CCS) or Certified Professional Coder (CPC ...
Volunteer work and internships for academic credit are not counted. Certifications & Licensures: RHIA Certification, CPMA, CCDS, Certified Coding Specialist (CCS) or Certified Professional Coder (CPC ...
Volunteer work and internships for academic credit are not counted. Certifications & Licensures: RHIA Certification, CPMA, CCDS, Certified Coding Specialist (CCS) or Certified Professional Coder (CPC ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
Louisville, KY · On-site
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
Louisville, KY · On-site
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
$78.33K - $168.71K/yr
Understands HCC (Hierarchical Condition Categories) documentation, ICD-10 (International Classification of Diseases-10) Coding, and Health Risk Assessments (HRAs). * Passion for teamwork and the ...
The role requires strong risk management skills and the ability to work closely with vulnerable ... Reasonable Adjustments: If you consider yourself to have a disability or require any reasonable ...
The role requires strong risk management skills and the ability to work closely with vulnerable ... Reasonable Adjustments: If you consider yourself to have a disability or require any reasonable ...
| Aspect | Internship Hcc Risk Adjustment Coder | Hcc Risk Adjustment Coder |
|---|---|---|
| Credentials | Typically none or basic certifications | Certifications like CPC, CCS, or RHIT often required |
| Work Environment | Internship setting, training-focused | Full-time professional setting, independent work |
| Employer & Industry | Hospitals, healthcare providers, training programs | Healthcare organizations, insurance companies |
| Search & Comparison Intent | Learning, entry-level roles, training | Professional, experienced roles, career advancement |
The Internship Hcc Risk Adjustment Coder is an entry-level position designed for training and gaining experience, often without requiring certifications. In contrast, the Hcc Risk Adjustment Coder is a full-time professional role that typically requires relevant certifications and experience. Both roles are within the healthcare industry, but they differ significantly in responsibilities, expectations, and career progression.
$143.62K - $229.79K/yr
Other
Medical, Dental, Vision, Retirement, PTO
Posted 24 days ago
7.8
Based on 13 frontline employees who took The Breakroom Quiz
163rd of 259 rated insurance
Job Description
As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include leading pricing strategies and actuarial initiatives for business segments, evaluating advanced care management models, conducting competitive benchmarking analyses, and designing and pricing sophisticated insurance products. You will support company objectives by providing reliable, actionable actuarial insights and recommendations, proactively identifying and addressing complex risks and opportunities. This position requires adaptability to the evolving landscape of the industry, ensuring our actuarial practices remain at the forefront of innovation and excellence.What You'll Do
Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work
Provide proactive and strategic thought leadership of ways to improve processes, reduce risks, and meet department and enterprise objectives to achieve profitable growth and/or improve value, quality, and access for Blue Cross NC customers
Achieve segment financial targets and provide concise explanations of results and variances to expectations; act as a financial steward for the company
Communicate effectively with all levels and divisions within the organization, including Divisional Leadership
Manage external partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts and/or rates
Develop and maintain strong business relationships with internal partners through business expertise and exceptional support; act as a strategic advisor
Meet continuing education standards required for job function, thought leadership and maintenance of actuarial credentials
What You Bring
Bachelor's degree or advanced degree (where required)
Member of the American Academy of Actuaries
Fellow of the Society of Actuaries
7 years of relevant actuarial experience, related experience may be considered.
In lieu of an FSA, will consider candidates who are an Associate of the Society of Actuaries (ASA) and have at least 9 years of relevant actuarial experience.
Bonus Points
Deep experience with ACA Risk Adjustment, including HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred
Proven expertise in ACA Risk Adjustment transfer forecasting and explanation of results to senior leadership - Highly Preferred
Strong understanding of diagnosis coding (ICD-10-CM), provider documentation practices, and their impact on risk adjustment outcomes.
Advanced analytical skills to identify risk adjustment leakage, emerging risks, and optimization opportunities across ACA populations
What You'll Get
The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.
Work-life balance, flexibility, and the autonomy to do great work.
Medical, dental, and vision coverage along with numerous health and wellness programs.
Parental leave and support plus adoption and surrogacy assistance.
Career development programs and tuition reimbursement for continued education.
401k match including an annual company contribution
Learn more
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
Actuarial Analysis, Actuarial Management, Actuarial Science, Actuarial Services, Affordable Care Act (ACA), Complex Care Management, Financial Reporting and Analysis, Hiring Management, Insurance Industry, Organizational Leadership, Regulatory Compliance_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.
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Insurance services
5,001 - 10,000 Employees
Durham, NC, US
1933
