Blue Cross Blue Shield - Meridian, ID

posted 2 months ago

Full-time - Entry Level
Remote - Meridian, ID
Insurance Carriers and Related Activities

About the position

The Risk Adjustment Medical Coder at Blue Cross of Idaho is responsible for medical record retrieval and over-reads for audit project activities related to risk adjustment and revenue accuracy. This role involves collaboration with cross-functional teams to ensure coding, documentation, and reporting accuracy, with a preference for candidates based in Meridian, Idaho, offering hybrid or remote work options.

Responsibilities

  • Monitor audit project activities and perform outreach to physician groups and contracted vendors for chart procurement.
  • Research and resolve non-retrievable chart case inventory.
  • Retrieve medical records via electronic and on-site methods.
  • Review, interpret, audit, code, and analyze medical records, claims, and encounter information related to Hierarchical Condition Categories (HCC).
  • Ensure vendor coding guidelines align with official ICD guidelines, CMS rules, and organizational policies.
  • Assist in the development of risk adjustment documentation, coding tools, and resources.

Requirements

  • Must hold Certified Professional Coder (CPC) certification.
  • Must hold or acquire Certified Risk Adjustment Coder (CRC) certification within one year of hire.
  • 3+ years of experience in the health industry, including medical record coding, preferably with HCC and/or Risk Adjustment coding experience.

Nice-to-haves

  • Certified Risk Adjustment Coder (CRC) at the time of application.
  • Associate or Bachelor Degree in a relevant field.
  • Knowledge of ICD-9-CM/ICD-10-CM and HCPCS code sets.
  • Knowledge of billing/claims submission and HIPAA guidelines.
  • Familiarity with medical terminology, anatomy, physiology, and pharmacological concepts.
  • Experience with Electronic Medical Record (EMR) applications.

Benefits

  • Health and wellness programs
  • Career development resources and training
  • Community involvement opportunities
  • Flexible work arrangements
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