Risk Adjustment QA Coordinator

BlueCross BlueShield of Tennessee • Chattanooga, TN

16h

About The Position

The Risk Adjustment team at BCBST is seeking a skilled and detail‑driven QA (Quality Assurance) Coordinator who is passionate about supporting coder excellence and strengthening overall quality. In this role, you will review coding work using ICD‑10 Guidelines and internal company standards, providing clear, supportive, and actionable feedback that helps coders grow and consistently perform at their best. Your impact will be immediate, as your insights elevate team accuracy, reinforce compliance, and contribute to a strong culture of continuous improvement. This position also offers a refreshing shift from daily production coding, giving you more autonomy, greater variety, and meaningful opportunities to coach, guide, and influence outcomes across the team. What You Will Do Perform quality assurance reviews on risk adjustment data submitted to CMS. Evaluate coding accuracy using ICD‑10 Guidelines and internal policies. Provide constructive, compassionate, and actionable feedback to coders. Partner with leadership to identify trends and recommend quality improvements. Support the development of educational materials and training initiatives. Contribute to overall compliance and documentation integrity. What We Are Looking For Exceptional attention to detail with the ability to identify patterns and inconsistencies. Confidence in asking thoughtful questions to gain clarity and strengthen understanding. Strong communication skills, including the ability to deliver corrective feedback clearly, respectfully, and with compassion. Commitment to continuous improvement, collaboration, and coder success. We're also interested in candidates who have an interest in leveraging approved AI tools such as CoPilot, to support efficiencies in our area. Why This Role Matters Directly influences coding quality and organizational compliance. Strengthens team skill sets through consistent, supportive coaching. Contributes to accurate, complete, and compliant risk adjustment submissions. Shapes a positive, growth‑minded culture within the coding team.

Requirements

• Associates degree in related healthcare field or equivalent years of experience. Equivalent years of experience are defined as one year of professional experience for every year of college requested.
• 1 year - Progressive medical coding and health care experience required.
• Professional coding certification from AHIMA or AAPC (CPC, CCS, RHIT, RHIA)
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Demonstrated presentation and team facilitation skills.
• Proficient in MicroSoft Office (Outlook, Word, Excel, Access and PowerPoint).
• Accuracy and attention to detail.
• Capacity to solve problems and manage multiple assignments with critical deadlines.
• Excellent oral and written communication skills.
• Strong interpersonal and organizational skills.
• Strong analytical skills.
• Positive attitude, self-driven, engaging, proactive, results drive.
• Must have exceptional Quality and Productivity performance.
• Understanding of ICD-10 coding standards required.
• Must acquire the Certified Risk Adjustment Coder (CRC) certificate from AAPC within one year, after completed training.

Nice To Haves

• interest in leveraging approved AI tools such as CoPilot, to support efficiencies in our area

Responsibilities

• Perform comprehensive 2nd pass reviews of medical records, prospective assessments, physician assessment forms (PAFs) and medical claims in accordance with CMS risk adjustment diagnosis coding guidelines.
• Maintain compliance with CMS risk adjustment diagnosis coding guidelines through identification of HCC adds and deletes.
• Assist with the intake and quality assurance of medical records as necessary.
• Perform or participate in special projects as directed by management.
• ICD-10 Coding assessment is required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree