Remote Risk Adjustment Coding Specialist — Mentor

CareFirst, Inc.; Baltimore (MD); Hybrid; USD 52,000 - 95,000; Full time

Job summary

CareFirst, Inc. is seeking a Risk Adjustment Coding Specialist to support retrospective risk adjustment and RADV activities, reviewing medical records for accurate coding and helping develop Commercial Risk Adjustment guidelines.

The role is remote from the greater Baltimore/Washington area with periodic on-site meetings; requires 3 years of HCC coding experience and an Associate's Degree in Health IT or related field, plus relevant credentials.

Qualifications

• Education level as described: Associate's Degree in Health Information Technology, Business or related field, or, in lieu of an Associate degree, an additional 2 years of relevant work experience.

Responsibilities

• Verify accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation; maintain coding accuracy >90%.
• Identify discrepancies and propose coding changes; develop coding guidelines for Commercial Risk Adjustment.
• Provide guidance to junior staff and lead in complex chart reviews and education sessions.

Skills

Adobe Acrobat Pro

MS Word

MS Excel

MS Outlook

Claims Processing

Facets

EMR/EHR systems

Education

Associate's Degree in Health Information Technology or related field

Tools

EMR/EHR platforms

Job description

CareFirst, Inc. is seeking a Risk Adjustment Coding Specialist to support retrospective risk adjustment and RADV activities, reviewing medical records for accurate coding and helping develop Commercial Risk Adjustment guidelines.

The role is remote from the greater Baltimore/Washington area with periodic on-site meetings; requires 3 years of HCC coding experience and an Associate's Degree in Health IT or related field, plus relevant credentials.