Risk Adjustment Coding and Outreach Speciallist

Blue Cross and Blue Shield of Kansas•Topeka, KS

1d•$27 - $34•Hybrid

About The Position

Under the direction of the Supervisor, Risk Adjustment Coding and Outreach, this position will be responsible for the ICD-10-CM diagnosis code capture for Affordable Care Act (ACA) and Medicare Risk Adjustment initiatives to include CMS required Medicare and Commercial Risk Adjustment and Risk Adjustment Data Validation (RADV) audits. The responsibilities of this position significantly impact the company's risk adjustment revenue opportunities. This position will retrieve, review, and analyze medical records for documentation to substantiate the medical diagnosis codes submitted on claims. Activities also include member and provider communication and education, scheduling, and process performance measurement to support closing both risk adjustment and quality care gaps. This position is in a fast-paced, developing area. “This position is eligible to work remote, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

Requirements

High school diploma or equivalent is required
AAPC or AHIMA coding certification required
One year of experience to include coding, billing, claims auditing
Extensive knowledge of and ICD-10CM coding guidelines.
Ability to consistently meet established minimum coding quality standards in a production environment.
Ability to assimilate and adapt quickly and accurately to coding guideline and/or other job-related changes.
Requires close attention to detail, strong grammar and reading comprehension skills, along with strong critical thinking and problem-solving skills.
Ability to work independently with minimum supervision, excellent reliability, and demonstrated ability to work timely and effectively under strict deadlines.

Nice To Haves

Risk adjustment HCC coding experience is preferred

Responsibilities

Ensures compliance with all applicable Federal, laws and regulations related to coding and documentation guidelines for Commercial and Medicare Risk Adjustment Payment System.
Performs medical record review to capture of all relevant diagnosis codes included in the CMS and HHS Hierarchical Condition Categories (HCC) conditions for Commercial and Medicare Risk Adjustment Payment system.
Abstract diagnostic data and properly assign ICD-10-CM codes for both health Hierarchical Condition Categories (HCC) and Rx HCCs that map to a Risk Adjusted HCC ensuring the documentation meets all CMS standard requirements for valid HCC Submission.
Selects and accurately records all appropriate records and data on assigned chart abstraction projects.
Utilize medical coding software programs to abstract, analyze, and/or evaluate clinic documentation and enter diagnosis codes.
Comply with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, and compliance with Risk adjustment production standards
Must meet 95% coding accuracy within 6 months and maintain accuracy in conjunction with department coding production guidelines.
Research and review provider submitted claims though Imaging resources.
Ability to learn and understand Natural Language Processing software (NLP).
Make recommendations for process improvements to further enhance coding quality and outcomes.
Complies with policies and procedures for confidentiality of all patient records and security of systems as required by HIPAA Privacy regulations.
Responsible for continuous improvement and ensuring a high-level of accuracy on internal chart audits.