Remote Risk Adjustment Coder Jobs in Bristol, RI

Pay Range:

Please emailHR_Talent_AcquisitionTeam@bcbsri.orgif you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI, our greatest resource is our people.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well.

We recognize that to do your best work, you have to be your best self.
It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We're dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Why this job matters:

Plays a critical role in shaping the organization's strategic direction by producing highquality financial insights that drive sound decisionmaking. Lead the financial support for provider and vendor valuebased care modeling, risk adjustment analytics, and pharmacy rebate activities. Ensure alignment with organizational goals by collaborating effectively across teams, enhancing financial performance, ensuring compliance, and strengthening analytical capabilities across the organization.

What you will do:

• Lead financial modeling and analytics to support provider and vendor valuebased care (VBC) program design, performance monitoring, and contractual settlement analysis.

• Serve as the primary financial partner for risk adjustment forecasting, revenue optimization analyses, and scenario modeling.

• Oversee the analysis and reconciliation of pharmacy rebate performance, trends, and forecast inputs.

• Translate complex financial, actuarial, and clinical information into actionable insights for senior leadership.

• Partner with Actuarial, Clinical, Pharmacy, and Network Management teams to ensure alignment of financial methodologies and assumptions across the enterprise.

• Facilitate decisionmaking by presenting financial scenarios, identifying risks, and recommending strategic pathways.

• Ensure adherence to financial, regulatory, and operational policies related to VBC, risk adjustment, and pharmacy programs.

• Develop and maintain standardized financial models, reporting tools, and documentation to support accuracy, transparency, and repeatability.

• Identify opportunities to streamline analytical workflows, improve data quality, and enhance forecasting and modeling accuracy.

• Other duties as assigned.

What you need to succeed:

• Bachelor's degree in Finance, Accounting, Economics, Data Analytics, Healthcare Administration, Mathematics, or a related field (or equivalent experience).

• Seven to ten years of experience in financial analysis, healthcare analytics, actuarial support, or similar quantitative roles.

• Advanced proficiency in financial modeling, forecasting, and data analysis.

• Strong technical skills with tools such as Excel, SQL, Power BI/Tableau, or Python.

• Demonstrated ability to manage complex datasets and produce clear, actionable insights.

• Excellent communication skills, with the ability to simplify complex concepts for diverse audiences.
• Knowledge of Federal Acquisition Regulations and Cost Accounting Standards.

The extras:

• Experience with valuebased care financial models (shared savings, risk corridors, capitation, bundled payments, etc.).
• Familiarity with Medicare Advantage, commercial risk adjustment, HCC methodologies, or Part D revenue models.

• Knowledge of pharmacy rebate programs, PBM financial structures, and drug utilization analytics.

• Prior experience in a health plan, provider organization, or healthcare consulting environment.

• Project leadership experience, including guiding analysts or crossfunctional workstreams.
• Understanding of budgeting principles.

Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
  

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer.

The law requires an employer to post notices describing the Federal laws. Please visitwww.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.