Remote Risk Adjustment Coding Specialist — Lead & Educate

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

Job summary

CareFirst BlueCross BlueShield is seeking a Risk Adjustment Coding Specialist to support retrospective risk adjustment filing, HHS-Risk Adjustment Data Validation (RADV) audits, and related chart coding functions. The role includes complex medical record review and coding, adherence to federal/state regulations, and developing commercial risk adjustment guidelines.

The position requires 3 years of HCC coding experience and an Associate's Degree in Health Information Technology or equivalent

Qualifications

• Education: Associate's Degree in Health Information Technology or equivalent with additional experience.
• 3 years of risk adjustment/HCC coding experience.
• Must be able to work remotely from within the greater Baltimore/Washington area and travel occasionally.

Responsibilities

• Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation and coding guidelines.
• Identifies coding discrepancies and informs management for quality improvements and education.
• Guides and mentors junior Coding Specialists on complex medical records and coding practices.

Skills

Attention to detail

Communication

Customer service

Time management

Flexibility

Education

Associate's Degree in Health Information Technology

Tools

Adobe Acrobat

Microsoft Word

Microsoft Excel

Outlook

EMR/EHR systems

Facets

Job description

CareFirst BlueCross BlueShield is seeking a Risk Adjustment Coding Specialist to support retrospective risk adjustment filing, HHS-Risk Adjustment Data Validation (RADV) audits, and related chart coding functions. The role includes complex medical record review and coding, adherence to federal/state regulations, and developing commercial risk adjustment guidelines.

The position requires 3 years of HCC coding experience and an Associate's Degree in Health Information Technology or equivalent