Medical Coding Reviewer - Risk Adjustment

Florida Blue Group; Northern (KY); Hybrid; USD 39,000 - 62,000; Full time

Benefits offered by this job

Health insurance

Retirement plan with employer match

Paid time off

Job summary

Florida Blue Group is seeking a Risk Adjustment Coder to work remotely, collaborating with a dynamic team to ensure accurate diagnosis coding for risk adjustment. You will review records and apply ICD-10 codes in a compliant and timely manner.

Under the Sr. Manager Risk Adjustment Audit, you will meet production targets while upholding 95% quality in coding and participate in process improvements. A strong medical terminology background and remote-work capability are essential.

Qualifications

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

Responsibilities

• Review inpatient and/or outpatient records to assign diagnosis codes using ICD-10 to ensure accuracy and compliance in risk adjustment.
• Review and validate provider-submitted documentation and codes for accuracy.
• Meet production targets while maintaining 95% quality audit accuracy.
• Document coder observations not captured in standard records.
• Assist Provider Educator during audit results presentations.
• Update SOPs, DTPs, and related documents.
• Participate in coding tool enhancements and process improvements.

Skills

Independent work ethic

Detail oriented

Medical terminology knowledge

ICD-10-CM coding knowledge

Education

CPC/CCSP or AHIMA credential

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,

Under the direction of the Sr. Manager Risk Adjustment Audit, the Risk Adjustment Coder is responsible for reviewing medical records to apply appropriate diagnosis coding in compliance with International Classification of Diseases, Tenth Revision (ICD-10) coding guidelines for the purposes of risk adjustment.

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.