Risk Adjustment Coding Specialist (Hybrid)

CareFirst BlueCross BlueShield; Baltimore (MD); Hybrid; USD 51,984 - 95,304; Full time

Job summary

CareFirst BlueCross BlueShield is looking for a Risk Adjustment Coding Specialist in Baltimore, Maryland. This role involves reviewing and coding medical records, ensuring compliance with federal and state guidelines. You will also develop coding guidelines and provide guidance to junior specialists. The position supports a hybrid working model and offers a salary range between $51,984 and $95,304.

The ideal candidate will have an Associate degree in Health Information Technology and at least 3 years of coding experience. Required certifications include CCS or CPC upon hire.

Qualifications

• 3 years of risk adjustment/HCC coding experience required.
• CCS-Certified Coding Specialist or CPC, CCS-P, CRC required upon hire.
• RHIT or RHIA preferred upon hire.

Responsibilities

• Verify accuracy and appropriateness of diagnosis codes based on medical documentation.
• Collaborate with leadership and vendors on medical record diagnoses.
• Guide and mentor less experienced staff.

Skills

Adobe Acrobat Professional

Microsoft Word

Microsoft Excel

Claims Processing

Facets

Communication skills

Customer service

Education

Associate degree in Health Information Technology or related field

Job description

Position Overview

The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, HHS‑Risk Adjustment Data Validation (RADV) audit, and other chart coding functions by performing moderately complex medical record review and coding, ensuring compliance with all applicable federal, state, and county laws and regulations related to coding and documentation guidelines.

Responsible for developing and maintaining the Commercial Risk Adjustment Coding guidelines and guiding junior coding specialists. The role requires a hybrid work model with portions of the week performed from home and at a CareFirst location.

Essential Functions

• Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation, utilizing appropriate coding guidelines and recommending changes as necessary, achieving and maintaining coding accuracy levels greater than 90%.
• Identifies and documents coding observations or discrepancies and provides information to the management team to enhance quality and/or provider education.
• Collaborates with leadership and third‑party vendors to negotiate agreement on complex medical record diagnoses in accordance with federal coding guidelines.
• Develops and conducts new physician/other healthcare practitioner coding orientation and education, including group or individual sessions.
• Provides guidance and direction to Coding Specialists when reviewing complex medical records.

Supervisory Responsibility

The position does not have direct reports but assists in guiding and mentoring less experienced staff and may lead a matrixed team.

Qualifications

Education Level: Associate degree in Health Information Technology, Business or related field, or equivalent experience (additional 2 years of relevant work experience).

Experience: 3 years risk adjustment/HCC coding experience.

Licenses/Certifications: CCS‑Certified Coding Specialist or CPC, CCS‑P, CRC (required upon hire); RHIT or RHIA (preferred upon hire).

Knowledge, Skills & Abilities

• Adobe Acrobat Professional.
• Microsoft Word, Excel, Outlook, Claims Processing, Facets.
• Ability to adapt to various coding technology platforms, such as EMR or EHR systems and coding documentation platforms.
• Effective communication and positive customer service to all internal and external customers.

Travel Requirements

Estimated 5% travel to medical sites for supervising record retrieval and conferences.

Salary Range

$51,984 - $95,304.

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. The company provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Physical Demands

Primarily seated position; occasional walking or standing, regular use of hands, frequent speaking and hearing; lifting up to 25 pounds occasionally.

Eligibility

Must be eligible to work in the U.S. without sponsorship.