Risk Adjustment Medical Coder

Blue Cross of Idaho; Carmel (IN); On-site; USD 36,000 - 50,000; Full time

Benefits offered by this job

Paid time off

Paid holidays

Education reimbursement

401(k) matching

Life insurance

EAP

Adoption assistance program

Paid family leave program

Job summary

Blue Cross of Idaho is seeking a Risk Adjustment Medical Coder to manage medical record retrieval and over-reads for audit activities related to risk adjustment and revenue accuracy.

You will collaborate with cross-functional teams to ensure coding, documentation, and reporting accuracy, leveraging 3+ years in health care and CPC/CRC credentials to support program needs.

Qualifications

• 3+ years of health industry experience including medical record coding.
• Experience with HCC or Risk Adjustment coding is preferred.
• CPC and CRC certifications or eligibility within one year of hire.

Responsibilities

• Monitor and perform initial/outreach for chart procurement from physician groups or vendors.
• Research and resolve non-retrievable chart case inventory.
• Retrieve records via electronic or on-site methods.
• Review, interpret, audit, code, and analyze medical records and claims for HCC.
• Ensure alignment with ICD guidelines, CMS rules and organizational policies.
• Assist in development of risk adjustment documentation, coding tools and resources.

Skills

CPC Certification

CRC Certification

Medical Coding

HCC Coding

ICD-10-CM CPT HCPCS

Microsoft Office

Education

Associate or Bachelor Degree

Job description

Blue Cross of Idaho is looking for Risk Adjustment Medical Coder who will be responsible for the medical record retrieval and over-reads for audit project activities as they relate to risk adjustment and revenue accuracy. Collaborate and support cross-functional teams needed for various risk adjustment program efforts to ensure coding, documentation, and reporting accuracy.

Required Experience

3/+ years’ experience in health industry (healthcare and/or health insurance) to include medical record coding, preferably with HCC and/or Risk Adjustment coding experience.

Required Certifications

Certified Professional Coder (CPC) In addition to CPC, must also hold, or acquire within one year of hire: Certified Risk Adjustment Coder (CRC)

Preferred Qualifications

Certified Risk Adjustment Coder (CRC), at time of application Clinical Certification (CNA, MA, or above); Associate or Bachelor Degree Proficient coding experience with ICD-10-CM, CPT and HCPS code sets

Helpful Knowledge

Billing/Claims submission HIPAA guidelines Medical terminology and abbreviations, anatomy, physiology, pathological process of diseases and basic pharmacological concepts Electronic Medical Record (EMR) applications and contents Standards of ethical coding as set forth by the American Academy of Professional Coders (AAPC)

Skills

• Creative, critical, interpersonal, and analytical thinking skills with a strong attention to detail
• Strong verbal and written communication, including presentation preparation/development
• Communicate effectively and professionally with all levels of professionals both within the organization and with external organizations; can work with and support cross-functional teams in a fast-paced environment
• Microsoft Office (Word, Excel, PowerPoint)
• Proficient coding (ICD, CPT, and HCPCS) both professional and institutional, with proven track record of coding accuracy
• Learns quickly and stays on-task through completion of assigned duties.
• Task and results oriented; self-motivated to request or tackle additional work.
• Follows verbal instructions and written policies and procedures

Your day may look like

• Monitors audit project activities to perform initial and/or follow-up outreach to physician groups and/or contracted vendors for chart procurement.
• Researches and resolves non-retrievable chart case inventory.
• Retrieves records via various electronic and on-site methods.
• Reviews, interprets, audits, codes, and analyzes medical records, claims and encounter information as it pertains to Hierarchical Condition Categories (HCC).
• Review’s vendor coding guidelines to ensure alignment with official ICD guidelines, CMS rules and regulations and the organizations policies and procedures.
• Assists in the development of risk adjustment documentation, coding tools, and resources.

Pay Range

As of the date of this posting, a good faith estimate of the current pay range is$26.12 to $36.58. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.

Benefits

• paid time off
• paid holidays
• community service and self-care days
• medical/dental/vision/pharmacy insurance
• 401(k) matching and non-contributory plan
• life insurance
• short and long term disability
• education reimbursement
• employee assistance plan (EAP)
• adoption assistance program
• paid family leave program

We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Blue Cross of Idaho has taken our role as an Idaho-based health insurance company to heart since 1945. As a not-for-profit, we are driven to help connect Idahoans to quality and affordable healthcare while building strong networks and services. We aim to create a brighter future for all with the help of customer-centric professionals.

Your Health and Wellness Matters

At Blue Cross of Idaho, we care about the health and well-being of our employees. Our benefits aim to help make your life easier, healthier and more balanced.

Your Career Development Matters

We believe in employee growth, which is why we offer training, tools and numerous resources to assist with professional development.

Your Community Matters

Our employees care deeply about Idaho. We work together to positively impact communities throughout Idaho, and contribute our time through volunteering.

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