Risk Adjustment Medical Coder

Blue Cross of Idaho Health Service; Meridian (MS); On-site; USD 36,000 - 50,000; Full time

Benefits offered by this job

PTO

Paid holidays

Health insurance

Dental insurance

Vision insurance

401(k) matching

Life insurance

Disability insurance

Education reimbursement

Employee assistance program (EAP)

Adoption assistance

Paid family leave

Job summary

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

The role requires 3+ years in healthcare coding with CPC and CRC certifications to be completed within one year. Strong knowledge of ICD-10-CM, CPT, and HCPCS is essential, along with experience in EMR systems.

Qualifications

• 3+ years of health industry coding experience including medical records.
• CPC certification required; CRC within one year of hire.
• Proficient in ICD-10-CM, CPT and HCPCS coding.

Responsibilities

• Monitor audit project activities and outreach for chart procurement.
• Retrieve records via electronic and on-site methods.
• Review, audit, code and analyze medical records and claims for HCC.
• Ensure alignment with ICD guidelines, CMS rules and internal policies.
• Assist in developing risk adjustment documentation and tools.

Skills

Attention to detail

Verbal and written communication

Cross-functional collaboration

Proficient coding (ICD CPT HCPCS)

Microsoft Office

Tools

EMR applications

Coding software

Microsoft Excel

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

Additionally 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.

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.

We offer a robust package of benefits including 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 and 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.