HCC Coder - Remote AZ

Blue Cross Blue Shield of Arizona; United States; Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Remote work 70%

Travel to office/providers as needed

Job summary

Blue Cross Blue Shield of Arizona is seeking a Coder Specialist to perform medical record reviews and abstract the most specific codes from documentation. The role supports CMS risk adjustment to influence future payments and requires coding from face-to-face visits with certified providers.

The position emphasizes HIPAA compliance, accuracy (QA 95%+), and ongoing education. Remote work is primarily 70% with occasional travel to the office or provider sites for education and meetings.

Qualifications

• Knowledge of anatomy and physiology, major disease processes, and pharmacology.
• Understanding etiology, pathology, signs and symptoms, diagnostic studies and treatments.
• Knowledge of CMS and Commercial Health Plans and their requirements.
• Strong customer service skills and techniques.
• Strong knowledge of HEDIS measures and their requirements.
• Strong knowledge of risk adjustment and HCC coding.

Responsibilities

• Perform medical record reviews and data abstraction with high specificity.
• Abstract diagnoses based on documentation from face-to-face visits with eligible providers.
• Ensure codes come from appropriate provider documentation and ICD-9/ICD-10 guidelines are followed.
• Communicate documentation inefficiencies to Clinical Correlations team.
• Maintain coding certification and stay updated on industry changes.
• Adhere to HIPAA and patient confidentiality requirements.
• Travel to office as needed for meetings or provider visits; 70% remote work is expected.
• Maintain QA accuracy of 95% or better in audits.

Skills

Anatomy & physiology

Etiology & pathology

CMS & health plans

HEDIS measures

Risk adjustment coding

Communication 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 methodology
• Accurately and efficiently conduct medical record review/ data abstraction
• Communicate documentation inefficiencies to Clinical Correlations team
• Position 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 education
• Must 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 capture
• Complete 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 staff
• Maintain coding certification and keep up to date on industry changes
• Abide by all HIPAA and associated patient confidentiality requirements
• Analyze data and report to Management any inaccuracy of claims data to the best of coders knowledge
• Provide feedback to Clinical Correlations and Manager on education needs identified
• Perform all other duties as assigned
• The 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/pharmacology
• Knowledge of understanding etiology, pathology, signs and symptoms, diagnostic studies and treatment modalities
• Knowledge of CMS and Commercial Health Plans
• Strong customer service skills and techniques
• Strong knowledge of HEDIS measures and their requirements
• Strong knowledge of risk adjustment/HCC coding

Required Professional Competencies

• Strong oral and written communication skills
• Ability to effectively interact with staff, customers and management at all levels
• Demonstrates 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.