Senior QA Coder/Auditor — Risk Adjustment & HCC

Blue Cross Blue Shield of Arizona; Phoenix (AZ); Hybrid; USD 95,000 - 130,000; Full time

Job summary

Blue Cross Blue Shield of Arizona seeks a Quality Assurance Coder/Auditor to lead risk mitigation education for primary care providers and staff. You will review records, identify at-risk HCCs, and suggest coding improvements based on Medicare guidelines.

The role requires CCS-P/CRC/CPC/COC credentials, 5+ years in coding with HCC, and 2+ years auditing; hybrid role within Arizona, standard 40 hours weekly, with ongoing education duties.

Qualifications

• 5 years of professional coding experience, with at least 3 years of HCC coding.
• 2 years of HCC auditing experience and advanced knowledge of coding guidelines.
• CCS-P, CRC, CPC, or COC certifications required or in progress.
• High School Diploma or GED required; RHIT/RHIA preferred.
• Strong written communication and education material development.

Responsibilities

• Review medical records, ensure completeness and accuracy for correct coding.
• Perform QA audits on vendor and provider group data submissions.
• Identify at-risk HCCs and provide corrective action recommendations.
• Develop and deliver provider/coder education to close healthcare gaps.
• Maintain current knowledge of Medicare Managed Care Manual and risk adjustment rules.
• Track QA audits and report findings to management monthly.

Skills

HCC coding

HCC auditing

CMS risk adjustment

MS Word

Excel

PowerPoint

Strong writing

Education

High School Diploma or GED

RHIT/RHIA or related preferred

Tools

MS Word

Excel

PowerPoint

Job description

Blue Cross Blue Shield of Arizona seeks a Quality Assurance Coder/Auditor to lead risk mitigation education for primary care providers and staff. You will review records, identify at-risk HCCs, and suggest coding improvements based on Medicare guidelines.

The role requires CCS-P/CRC/CPC/COC credentials, 5+ years in coding with HCC, and 2+ years auditing; hybrid role within Arizona, standard 40 hours weekly, with ongoing education duties.