Medical Coding Reviewer - Risk Adjustment

GuideWell; Northern (KY); Remote; USD 39,000 - 47,000; Full time

Job summary

GuideWell, a Florida Blue subsidiary, offers a fully remote Risk Adjustment Coder role in the United States. You will review inpatient/outpatient records and assign ICD-10 codes to support risk adjustment programs with strong quality control and production targets.

The position requires 2+ years of experience and active CPC/CCSP or AHIMA certification, plus ICD-10-CM proficiency and solid MS Office skills. A remote, detail-oriented professional who can work independently will thrive.

Qualifications

• High school diploma or GED is required.
• Active CPC/CCSP or AHIMA certification is required.
• 2+ years related work experience in medical coding.
• Ability to work independently in a remote environment.
• Proficient with ICD-10-CM guidelines for coding and reporting.
• Experience in a production-based environment is preferred.
• Strong medical terminology, abbreviations and anatomy knowledge.
• Intermediate MS Office proficiency.

Responsibilities

• Review inpatient and/or outpatient records to assign ICD-10 codes for risk adjustment.
• Validate provider/vendor Submitted codes and correct discrepancies for accuracy.
• Meet production targets while maintaining 95% quality audit accuracy.
• Document coder observations for non-production level support.
• Assist during audits by answering coding questions for provider groups.
• Update SOPs, DTPs and related documents; participate in process improvements.

Skills

Remote work

Medical terminology

ICD-10-CM guidelines

MS Office

Attention to detail

Education

High school diploma or GED

CPC/CCSP or AHIMA certification

CRC - AAPC certification (preferred)

Tools

Microsoft Office (Word, Excel, Outlook, PowerPoint)

Job description

Job Summary

As a Risk Adjustment Coder, you will work independently in a remote environment and collaborate with our team to ensure accuracy and quality in our diagnosis coding work. We offer the opportunity to work with a dynamic team in a remote environmentCompetitive salary and benefits packageProfessional growth and development opportunitiesIf you are a motivated and detail-oriented coding professional looking for a new challenge.

What You'll Be Doing

• Review inpatient and/or outpatient medical records to identify and assign relevant diagnosis codes using ICD-10 classification systems to ensure accuracy and compliance of risk adjustment. This may be in the form of ad hoc projects, provider quality audits, vendor overreads or RADVs.
• Review and validate provider-submitted and/or vendor-submitted medical record documentation and ICD-10 diagnosis codes to identify and correct any inaccuracies or discrepancies to ensure accuracy and compliance of risk adjustment.
• Responsible for meeting production targets while adhering to strict quality audit accuracy of 95%.
• Provide non-production level support by documenting coder observations that would not otherwise be captured through the diagnosis coding.
• Assist Provider Educator during audit results presentation with provider groups by answering diagnosis coding questions.
• Administrative duties including updating SOPs, DTPs and other related documents.
• Participating in process improvement initiatives such as but not limited to coding tool enhancements.

What We Require

• 2+ years related work experience
• High school diploma or GED
• Required active Certified Professional Coder American Association of Professional Coders CPC and/or CCSP OR (AAPC) or American Health information Management Association (AHIMA)
• Ability to work independently in a remote work environment.
• Proficient with ICD-10-CM Guidelines for coding and reporting.
• Previous work experience in production-based environment.
• Strong understanding of medical terminology, abbreviations, body systems/anatomy, physiology and concepts of disease processes.
• Intermediate level of Microsoft Office proficiency (Word, Excel, Outlook, PowerPoint).

What We Prefer

• CRC - Certified Risk Adjustment Coder from American Association of Professional Coders (AAPC)
• Coding or auditing experience in a Provider Group, Outpatient coding setting or Health Plan. Knowledge of Medicare Advantage and/or Affordable Care Act (ACA-Commercial) programs.
• Organizational skills, working effectively in a multi-task-based environment, and with an ability to work both independently and collaboratively.

General Physical Demands

• Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.
• Jobs are sedentary if traversing activities are required only occasionally.

What We Offer

As a Florida Blue employee, you will be at the heart of GuideWell's vision - to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, short- and long-term disability programs
• Leave programs to support personal circumstances
• Retirement Savings Plan including employer match
• Paid time off, volunteer time off, 10 holidays and 2 well-being days
• Additional voluntary benefits available; and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Typical Hourly Offer/Pay Range: $28 - $34

Hourly Pay Range: $28 - $45

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.