Medical Coding Auditor - Risk Adjustment

Premera Blue Cross

14d•$57,100 - $104,200•Remote

About The Position

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Inclusion, and America's Greatest Workplaces For Mental Well-Being, Forbes ranked Premera among America’s Best Midsize Employers for the fourth time. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/. The Medical Coding Auditor plays a crucial role in ensuring the accuracy and compliance of diagnostic coding within medical records. This position is essential for maintaining the integrity of Risk Adjustment and HCC coding. By leveraging a deep understanding of ICD-10 and other coding standards, the auditor reviews and researches provider diagnostic coding issues, performs detailed medical record reviews, and highlights documentation standards. This role also identifies opportunities for improving provider performance related to coding errors and documentation deficiencies. In addition to auditing, the Medical Coding Auditor conducts quality assurance (QA) reviews of peer and vendor coders to ensure coding accuracy, adherence to service level agreements, and performance guarantees. Feedback is provided where discrepancies are found, fostering a culture of continuous improvement.

Requirements

Bachelor's degree or four (4) years of relevant work experience (Required)
Three (3) years of experience as a RHIA, RHIT, or CPC certified coder within a healthcare provider organization or health insurance company (Required)
Current certification as a professional coder (RHIA, RHIT, or CPC) (Required)
CRC certification or willingness to obtain it within the first year of employment.

Nice To Haves

Additional certifications such as CCSP, CCS-H, CPC-P, and CPH-H are desirable.
Nursing or other clinical experience is a plus.

Responsibilities

Analyze medical claims data and associated documentation to ensure accurate and complete diagnostic risk capture.
Document findings, including diagnosis changes and opportunities for documentation improvement, and recognize trends.
Evaluate coding and documentation behavior, providing recommendations for provider improvement.
Interpret and apply policy and coding standards (e.g., Coding Clinic) that impact financial and operational aspects of risk adjustment coding.
Collaborate and communicate effectively with internal and external sources (auditors, vendors, and peers) to deliver QA findings, clearly articulating rationale supported by industry-standard evidence.
Maintain current knowledge of coding applications for ICD-10 and other applicable coding standards.
Perform other duties as assigned.

Benefits

Medical, vision, and dental coverage with low employee premiums.
Voluntary benefit offerings, including pet insurance for paw parents.
Life and disability insurance.
Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
Generous paid time off to reenergize.
Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries, team accomplishments, and more.
For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
Commuter perks make your trip to work less impactful on the environment and your wallet.
Free convenient on-site parking.
Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.