Government Programs Risk Adjustment Coder

Capital Blue Cross•Harrisburg, PA

3h•Remote

About The Position

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The Capital BlueCross Government Programs Risk Adjustment coding position is a unique position that combines knowledge and experience in risk adjustment coding, Medicare and Government regulations, Medicare Advantage risk adjustment model, HHS ACA risk adjustment models, and RADV and HRADV experience.

Requirements

High School Diploma or GED
Coding education including understanding of proper guidelines and usage of ICD-9-CM, CPT and HCPCS RHIT - Registered Health Information Technologist or CPC-P - Certified Professional Coder (Physician) or CCS-P - Certified Coding Specialist (Physician), and CRC-Certified Risk Adjustment Coding Credential required.
Prior HCC/HHS experience with Medicare Risk Adjustment with three (3) years’ experience in medical coding.
Familiarity with the CMS Medicare risk algorithm (CMS HCC) and the ACA risk algorithms (HHS HCC)
Active CRC credentials are required
Strong analytical skills.
Ability to problem solve.
Detail oriented with high degree of accuracy.
Ability to exercise discretion in handling confidential member information.
Strong commitment to customer service and understanding and responding to customer needs within specific timeframes.
Proficiency with Microsoft Word, Excel and PowerPoint or comparable software required.
Ability to work independently in a time-oriented environment
Demonstrated ability to interact with other departments.
Demonstrates openness, flexibility, problem solving, patience, and tact when dealing with providers, members and staff.
Knowledge of risk adjustment principles and coding updates.
While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
Possession of a valid state issued ID
Ability to travel to provider and member locations using reliable source of transportation.
Must reside within 50-mile radius of Harrisburg, PA.

Nice To Haves

Nursing licensure is considered a bonus.
Direct experience speaking with providers is preferred

Responsibilities

Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
Offer suggestions and assistance for improvement in departmental processes & other duties as assigned
Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
Maintains responsibility for conducting clinical chart and patient billing audits for the purpose of
Identifying and validating reported diagnoses for Medicare/Medicare Advantage and ACO health plan members.
Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
Adheres to all official coding rules and CMS guidelines for risk adjustment, and ensures accuracy,
Completeness, specificity and appropriateness of diagnosis information.
Assists with the completion of HEDIS chart reviews and facilitates the accurate and timely reporting of quality
Maintains established work production standards
Assumes responsibility for professional growth and development
Participates in professional healthcare and community associations to keep abreast of current healthcare trends is expected