Risk Adjustment Auditor/Coder

Blue Cross Blue Shield of Massachusetts • Hingham, MA

3d • $35 - $43 • Remote

About The Position

Ready to help us transform healthcare? Bring your true colors to blue. What we need The Risk Adjustment Auditor/Coder will code, abstract and analyze inpatient, outpatient and professional medical records using ICD-10 coding guidelines. The coder will perform these medical record reviews remotely to ensure proper medical diagnoses are coded appropriately and that the members’ medical records reflect them accurately in accordance with Official Coding Guidelines. This role is eligible for the following personas: E-Worker, Mobile and Resident. Your Day to Day Perform medical record reviews which include coding, abstracting and analyzing inpatient, outpatient and/or professional medical records using ICD-10 coding guidelines. Follows the Official ICD-10 guidelines for Coding and Reporting and has a complete understanding of these guidelines, as well as other official guidance such as CMS guidelines and AMA Coding Clinics. Ensure that all ICD-10 diagnoses are reported in accordance with CMS/HHS payment and Risk Adjustment guidelines. Consistently meet daily productivity expectations while maintaining a pre-determined level of coding quality and accuracy. Actively participate in internal / external meetings and training activities. Provide feedback and trending to leaders. Participate in special projects and other activities associated with the Risk Adjustment program as needed. Some travel to Massachusetts will be required as determined by leadership for onsite training and team collaboration. We're Looking for: Advanced knowledge of ICD-10 CM official coding guidelines, including the use of AHA Coding Clinic or similar authoritative resources. Excellent oral and written communication skills Ability to work independently in a fast-paced environment Ability to interact with management personnel and the provider community Possess strong organizational skills and attention to detail Adaptive and flexible to new ideas and change What You Bring: CPC coding certification from the AAPC or CCS from AHIMA required; CRC required within the first year of employment. 2-4 years risk adjustment coding experience required Expert knowledge of medical terminology and abbreviations and disease, illness and injury processes Working knowledge of CMS/HHS risk adjustment models required Associate’s degree or higher preferred Knowledge of Microsoft Office, including Word and Excel #LI-HYBRID Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above

Requirements

• Advanced knowledge of ICD-10 CM official coding guidelines, including the use of AHA Coding Clinic or similar authoritative resources.
• Excellent oral and written communication skills
• Ability to work independently in a fast-paced environment
• Ability to interact with management personnel and the provider community
• Possess strong organizational skills and attention to detail
• Adaptive and flexible to new ideas and change
• CPC coding certification from the AAPC or CCS from AHIMA required; CRC required within the first year of employment.
• 2-4 years risk adjustment coding experience required
• Expert knowledge of medical terminology and abbreviations and disease, illness and injury processes
• Working knowledge of CMS/HHS risk adjustment models required
• High school degree or equivalent required unless otherwise noted above

Nice To Haves

• Associate’s degree or higher preferred
• Knowledge of Microsoft Office, including Word and Excel

Responsibilities

• Perform medical record reviews which include coding, abstracting and analyzing inpatient, outpatient and/or professional medical records using ICD-10 coding guidelines.
• Follows the Official ICD-10 guidelines for Coding and Reporting and has a complete understanding of these guidelines, as well as other official guidance such as CMS guidelines and AMA Coding Clinics.
• Ensure that all ICD-10 diagnoses are reported in accordance with CMS/HHS payment and Risk Adjustment guidelines.
• Consistently meet daily productivity expectations while maintaining a pre-determined level of coding quality and accuracy.
• Actively participate in internal / external meetings and training activities.
• Provide feedback and trending to leaders.
• Participate in special projects and other activities associated with the Risk Adjustment program as needed.
• Some travel to Massachusetts will be required as determined by leadership for onsite training and team collaboration.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED