Medicare Risk Adjustment Program Support Specialist

Position DescriptionBase pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”Provides administrative support to Risk Adjustment team as directed by the Team Lead and/or Manager. This role performs administrative tasks that support Risk Adjustment programs and processes Including but not limited to coordinating collection of medical records, departmental documentation, and completion of member/provider communications.Responsibilities And QualificationsAssists with medical record documentation requests and leverages tools as available to process medical record receivables.Conducts fax and telephonic outreach; and written communications providers to communicate status of outstanding record requests or other needed informationActively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.Monitors and updates all department documentation at pre-determined cadence.Interacts courteously and professionally with internal staff, vendor partners, and providers, to support collaborative risk adjustment functions.Identifies opportunities and proposes alternatives for improving the Risk Adjustment functions.SkillsStrong organizational and time management skills.Demonstrated strong attention to detail and accuracy.Ability to follow job responsibilities as outlined in departmental policies and procedures.Excellent written and oral communication skills.KnowledgeWorking knowledge and operation of a personal computer, including proficiency in Microsoft Office applications.Working knowledge of medical terminology.Working knowledge of the health insurance industry, health plan benefits and product lines (e.g., PPO, POS, HMO, FEP, Senior Products, Traditional/Comprehensive).Knowledge of regulatory and accreditation standards and requirements (e.g. NCQA, CMS).Experience2 years' experience in the medical field (e.g. medical assistant, medical secretary) or in a managed care clinical department.Education And CertificationsHigh School Diploma required.Continued higher education preferred.About UsWe recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.