Risk Adjustment Medical Coder

Blue Cross of Idaho•Meridian, ID

2d•Hybrid

About The Position

Blue Cross of Idaho is seeking a Risk Adjustment Medical Coder responsible for medical record retrieval and over-reads for audit project activities related to risk adjustment and revenue accuracy. The role collaborates with and supports cross-functional teams on risk adjustment program efforts to ensure coding, documentation, and reporting accuracy. The position prefers a Meridian, Idaho location and offers a hybrid work location. The coder monitors audit activities and conducts outreach to physician groups and contracted vendors to obtain charts; researches unresolved, non-retrievable chart cases; retrieves records through electronic and on-site methods; and reviews, interprets, audits, codes, and analyzes medical records, claims, and encounter information related to Hierarchical Condition Categories (HCC). The role also reviews vendor coding guidelines for alignment with official ICD guidelines, CMS rules and regulations, and company policies, and assists with developing risk adjustment documentation, coding tools, and resources. The stated good-faith pay range is $26.12 to $36.58. The position is eligible for an annual incentive bonus that varies based on company and employee performance. The employer offers a benefits package including paid time off and holidays, insurance coverage, retirement plans, education reimbursement, and family-related benefits. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Blue Cross of Idaho is an Equal Opportunity Employer.

Requirements

At least 3 years of experience in the health industry (healthcare and/or health insurance), including medical record coding; HCC and/or risk adjustment coding experience is preferred.
Certified Professional Coder (CPC) certification.
Must also hold, or acquire within one year of hire, Certified Risk Adjustment Coder (CRC) certification.
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 effectively and professionally with professionals at all levels, internally and externally, and to support cross-functional teams in a fast-paced environment.
Microsoft Office skills, including Word, Excel, and PowerPoint.
Proficient coding in ICD, CPT, and HCPCS for professional and institutional records, with a proven track record of coding accuracy.
Ability to learn quickly, stay on task through assigned duties, work toward tasks and results, self-motivate to request or take on additional work, and follow verbal instructions and written policies and procedures.

Nice To Haves

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 processes, and basic pharmacological concepts.
Knowledge of electronic medical record (EMR) applications and contents.
Knowledge of ethical coding standards established by the American Academy of Professional Coders (AAPC).

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 medical records using 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 to ensure alignment with official ICD guidelines, CMS rules and regulations, and organizational policies and procedures.
Assist in developing risk adjustment documentation, coding tools, and resources.
Collaborate with and support cross-functional teams on risk adjustment program efforts to ensure coding, documentation, and reporting accuracy.