HCC Coder - Remote AZ

Blue Cross Blue Shield of Arizona; Phoenix (AZ); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Blue Cross Blue Shield of Arizona is seeking a Coder Specialist to perform medical record reviews and abstract the highest specificity codes for CMS risk adjustment. The role supports accurate risk adjustment factors used in payment determinations and requires a certified medical coder with ICD-9/ICD-10 knowledge.

The position is 70% remote with travel to the office or to visit network providers for education and meetings.

Qualifications

• Anatomy and physiology understanding.
• Knowledge of CMS/Commercial Health Plans requirements.
• HEDIS knowledge.
• Risk adjustment/HCC coding knowledge.

Responsibilities

• Conduct medical record reviews and data abstraction accurately and efficiently.
• Ensure ICD-9/ICD-10 coding per date of service and documentation.
• Communicate documentation inefficiencies to the Clinical Correlations team.
• Maintain coding certification and stay updated on industry changes.
• Interact professionally with care providers, clinics, hospitals and Medicaid staff.
• Position is 70% remote with travel to offices/providers as required.
• Full-time schedule: at least 40 hours per week.

Skills

Anatomy & physiology knowledge

Etiology & pathology understanding

CMS & health plan knowledge

HEDIS knowledge

Risk adjustment / HCC coding

Communication skills

Customer service skills

Job description

Purpose Of The Job

The Coder Specialist is to perform medical record reviews and abstract highest specificity codes effectively from medical records based on the documentation provided. This data is sent to CMS to determine accurate risk adjustment factor used to adjust payments for members' future healthcare cost. Medical record reviews will be retrospective and must be conducted by a certified medial coder. Codes will be sequenced and assigned by documentation in the medical record which most accurately describes each documented diagnosis. The coder is responsible for ensuring diagnosis codes selected come from a face to face visit with a valid Risk Adjustable provider. The diagnosis must be coded according to International Classification of Diseases (ICD) version 9 or 10 depending on date of service for coding and reporting.

Essential Job Functions And Responsibilities

Comprehensive understanding of Coding guidelines/rules, regulations and methodologyAccurately and efficiently conduct medical record review/ data abstractionCommunicate documentation inefficiencies to Clinical Correlations teamPosition is expected to be 70% remote with capability to travel into the office when required for meetings/education, or travel to visit network providers to provide trending coding educationMust have comprehensive understanding of the contents of a typical medical chart, medical terminology and abbreviations, ICD 9 / ICD 10 coding conventions and guidelines, what constitutes adequate substantiation of a diagnosis, and appropriate providers, documents and facilities for proper code captureComplete coding quality and accuracy maintaining industry standard of 95% or better in QA audits.Communicate effectively and professionally with care provider offices, clinics, hospitals, other clinical facilities and Medicaid Business Segment staffMaintain coding certification and keep up to date on industry changesAbide by all HIPAA and associated patient confidentiality requirementsAnalyze data and report to Management any inaccuracy of claims data to the best of coders knowledgeProvide feedback to Clinical Correlations and Manager on education needs identifiedPerform all other duties as assignedThe position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements

Required Job Skills

Knowledge of anatomy and physiology/major disease processes/pharmacologyKnowledge of understanding etiology, pathology, signs and symptoms, diagnostic studies and treatment modalitiesKnowledge of CMS and Commercial Health PlansStrong customer service skills and techniquesStrong knowledge of HEDIS measures and their requirementsStrong knowledge of risk adjustment/HCC coding

Required Professional Competencies

Strong oral and written communication skillsAbility to effectively interact with staff, customers and management at all levelsDemonstrates flexibility and willingness to embrace change

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group. Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com.