Remote Risk Adjustment Coder & HCC Expert

CareFirst BlueCross BlueShield; Baltimore (MD); Hybrid; USD 52,000 - 95,000; Full time

Job summary

CareFirst BlueCross BlueShield seeks an experienced Risk Adjustment Coding Specialist to support retrospective risk adjustment, RADV audits, and related coding functions. The role involves reviewing medical records, ensuring compliance with coding guidelines, and developing Commercial Risk Adjustment coding guidelines.

The position requires 3 years of HCC coding experience, RHIT/RHIA preferred, and CCS/CCS-P or CRC upon hire.

Qualifications

• Associate degree in Health Information Technology or related field required, or additional 2 years of relevant work experience.
• CCS-Certified Coding Specialist, CPS, CCS-P, CRC upon hire required; RHIT or RHIA preferred.
• Minimum 3 years of risk adjustment/HCC coding experience.
• Proficient in EMR/EHR platforms and coding documentation systems.

Responsibilities

• Verifies accuracy and appropriateness of diagnosis codes across complexity levels.
• Documents coding observations and negotiates with stakeholders on complex diagnoses.
• Leads coding orientation/education for physicians and staff.

Skills

HCC coding

Medical record review

EMR/EHR systems

Office software

Communication skills

Time management

Education

Associate degree in HIT/related

RHIT/RHIA preferred

Tools

Microsoft Word

Microsoft Excel

Outlook

Adobe Acrobat

Facets

Job description

CareFirst BlueCross BlueShield seeks an experienced Risk Adjustment Coding Specialist to support retrospective risk adjustment, RADV audits, and related coding functions. The role involves reviewing medical records, ensuring compliance with coding guidelines, and developing Commercial Risk Adjustment coding guidelines.

The position requires 3 years of HCC coding experience, RHIT/RHIA preferred, and CCS/CCS-P or CRC upon hire.