Risk Adjustment Medical Coder

Blue Cross of Idaho • Meridian, ID

3d • $26 - $37 • Hybrid

About The Position

Blue Cross of Idaho is seeking a Risk Adjustment Medical Coder to support medical record retrieval and over-reads for audit project activities related to risk adjustment and revenue accuracy. The role collaborates with cross-functional teams to support risk adjustment programs and ensure coding, documentation, and reporting accuracy. The position prefers a Meridian, Idaho location and offers a hybrid work arrangement.

Requirements

• At least 3 years of experience in the healthcare or health insurance industry, including medical record coding; HCC and/or risk adjustment coding experience is preferred.
• Certified Professional Coder (CPC) certification.
• Must hold or acquire Certified Risk Adjustment Coder (CRC) certification within one year of hire.
• Creative, critical, interpersonal, and analytical thinking skills, with strong attention to detail.
• Strong verbal and written communication skills, including presentation preparation and development.
• Ability to communicate professionally with people at all organizational levels and with external organizations, and to support cross-functional teams in a fast-paced environment.
• Microsoft Office skills, including Word, Excel, and PowerPoint.
• Proficient coding skills in ICD, CPT, and HCPCS for both professional and institutional coding, with a proven record of coding accuracy.
• Ability to learn quickly and stay on task through completion of assigned duties.
• Task- and results-oriented, self-motivated approach, including willingness to request or take on additional work.
• Ability to follow verbal instructions and written policies and procedures.

Nice To Haves

• Certified Risk Adjustment Coder (CRC) certification at the time of application.
• Clinical certification (CNA, MA, or above).
• Associate or bachelor's degree.
• Proficient coding experience with ICD-10-CM, CPT, and HCPCS code sets.
• Knowledge of billing and claims submission.
• Knowledge of HIPAA guidelines.
• Knowledge of medical terminology and abbreviations, anatomy, physiology, disease pathology, and basic pharmacological concepts.
• Knowledge of electronic medical record (EMR) applications and contents.
• Knowledge of AAPC ethical coding standards.

Responsibilities

• Monitor audit project activities and conduct initial or follow-up outreach to physician groups and contracted vendors to procure charts.
• Research and resolve non-retrievable chart case inventory.
• Retrieve records using various electronic and on-site methods.
• Review, interpret, audit, code, and analyze medical records, claims, and encounter information related to Hierarchical Condition Categories (HCC).
• Review vendor coding guidelines for alignment with official ICD guidelines, CMS rules and regulations, and organizational policies and procedures.
• Assist in developing risk adjustment documentation, coding tools, and resources.

Benefits

• Paid time off
• Paid holidays
• Community service and self-care days
• Medical, dental, vision, and pharmacy insurance
• 401(k) matching and non-contributory plan
• Life insurance
• Short- and long-term disability
• Education reimbursement
• Employee assistance plan (EAP)
• Adoption assistance program
• Paid family leave program
• Annual incentive bonus, variable depending on company and employee performance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed