Remote HCC Coder Specialist – Risk Adjustment

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

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.