Risk Adjustment Coder

Blue Cross and Blue Shield of Kansas City; Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization is seeking a Remote Risk Adjustment Coder to develop best practices for clinical coding programs. The role includes reviewing medical records, ensuring data accuracy, and evaluating risk scores. Applicants should have a bachelor’s degree, at least three years of medical coding experience, and the ability to achieve CRC certification within a year. The position offers a competitive total rewards package and supports professional development.

Benefits

Comprehensive medical, dental, and vision benefits

Annual incentive bonus plan

Paid time off including holidays and volunteer time

Tuition reimbursement program

Qualifications

• 3 years of medical coding experience in a healthcare plan or environment.
• 2 years of experience working in a medical information environment.
• Must obtain CRC within one year of employment.

Responsibilities

• Develop best practices for clinical coding programs in risk adjustment.
• Ensure accuracy and integrity of data submitted to CMS.
• Evaluate risk score and identify improvement opportunities.

Skills

Medical coding experience

Attention to detail

Expert knowledge of CMS-HCC

Education

Bachelor’s degree in business administration or BSN

CPC or equivalent certification

Tools

MS Excel

MS Project

Job description

Risk Adjustment Coder page is loaded## Risk Adjustment Coderlocations: Remotetime type: Full timeposted on: Posted 2 Days Agojob requisition id: R6794## **Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:*** ## **Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute*** ## **Annual incentive bonus plan based on company achievement of goals*** ## **Time away from work including paid holidays, paid time off and volunteer time off*** ## **Professional development courses, mentorship opportunities, and tuition reimbursement program*** ## **Paid parental leave and adoption leave with adoption financial assistance*** ## **Employee discount program**## **Job Description Summary:**Develops expert knowledge of the Centers for Medicare and Medicaid Services (CMS) Commercial Risk Adjustment and Medicare Advantage Rating models in order to develop best practices for clinical coding programs within our risk adjustment initiatives. In addition to ensuring the accuracy, quality, and integrity of the data gathered and submitted to CMS, this person will perform detailed and complex review of organizational programs in order to evaluate risk score and star measure outcomes and identify improvement opportunities.## **Job Description*** Reviews medical record and claims information to identify all appropriate coding based on Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC & HHS-HCC) models* Provides real time support and coordination visiting Primary Care Providers and Care Coordinators for Commercial Risk Adjustment coding education* Develops policies and procedures for system, application and related operational processes in order to ensure optimization and compliance with CMS risk adjustment and Star measurement coding guidelines* Abstract all risk adjusted diagnosis codes from acceptable provider documentation and in accordance with industry standards for coding and reporting.* Adheres to current industry standard, as defined in the ICD-10 guidelines for coding and reporting.* Conducts Provider queries for any documentation inconsistencies within client electronic medical record and/or other query system* Confirms accurate entry of risk adjusted codes into proprietary software or database as defined by project and client scope.* Must be able to maintain 95% accuracy and completeness in ongoing quality assurance reviews as required by internal QA policy.* Uses expert knowledge of CMS-HCC & HHS-HCC Risk Adjustment Model to provide support in forecasting care opportunities within Commercial risk adjustment and Medicare Advantage segments, coding of Diagnosis codes that pertain to HCCs* Provides encounter data reconciliation between CMS and health plan claims detail to ensure accurate risk adjustment payments* Additional duties as necessary to meet CMS guidelines and regulations* Develops and shares guidelines/best practices with internal risk adjustment coders to improve coding documentation techniques.* May develop policies and procedures for system, application and /or related operational processes in order to ensure optimization and compliance with CMS risk adjustment and Star measurement coding guidelines* May pull medical records for our risk adjustment/HEDIS/STARS projects* Helps with special projects within our Risk Adjustment Operations group**Minimum Qualifications*** Bachelor’s degree in business administration or Bachelor of Science in Nursing (BSN), health administration, or related field or an equivalent combination of education and experience.* 3 years of medical coding experience in a healthcare plan or environment* 2 years of experience working in medical information environment (ex. At health plan, provider office, hospital, etc.)* CPC (Certified Professional Coder) or Equivalent* Must obtain CRC within one year of employment**Preferred Qualifications*** 2 years of risk adjustment coding experience* Experience with MS Excel and MS Project* Risk Adjustment program experience* ICD-10 Proficiency* CRC (Certified Risk Adjustment Coder)**Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.**## **At Blue Cross and Blue Shield of Kansas City (Blue KC), we have long put our members first by developing products and services to meet their needs. From our founding in 1938 to more than 80 years of experience in innovative, patient-centered healthcare coverage, Blue KC continues to keep our members at the center of everything we do. As a market leader, we continue to embrace new ideas to make healthcare more affordable and to improve the customer experience. Come join us!****Blue Cross and Blue Shield of Kansas City will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully utilize electronic and online job application systems. For assistance, please send an email to** [e-mail]/Veterans/Disability Affirmative Action Employer