Remote HCC Coder - Medical Records & Risk Adjustment

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

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.