What are the responsibilities and job description for the Risk Adjustment Consulting, Experienced position at Blue Shield of CA?
Your Role
The Enterprise Retrospective Chart Review team oversees end to end retrospective coding operations, ensuring the accuracy, completeness, and compliance of medical record review across all risk adjusted lines of business. The team manages enterprise workflows, vendor performance, coding quality, audit readiness, and cross functional alignment with Clinical, Compliance, and Risk Adjustment partners.
Your Knowledge and Experience
- Requires a college degree or equivalent experience
- Requires 3 years of prior relevant experience within healthcare, preferably Risk Adjustment
- Requires practical knowledge of Risk Adjustment obtained through professional experience and advanced education
- Requires familiarity with AI tools, including prompt engineering and workflow automation
- Requires experience building dashboards or visual reports that support operational decision making
- Requires strong communication skills for concise summaries and effective cross functional collaboration
Hybrid
This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.