Blue Cross NC · 8 hours ago
Coding Specialist - Risk Adjustment
United States
Full-time
Remote
Mid Level
$46K/yr - $73K/yr
3+ years expBlue Cross NC is a healthcare organization seeking a Coding Specialist to analyze medical records and ensure compliance with coding standards. The role involves evaluating physician coding practices and reporting data to CMS, while maintaining professional relationships with medical providers.
Financial ServicesHealth InsuranceInsurance
Responsibilities
Analyzes necessary documentation, including medical records/charts, and applies clinical coding expertise to evaluate appropriateness of provider coding and reports relevant data to the Centers for Medicare and Medicaid Services (CMS)
Uses all resources to ensure compliance and understanding of the CMS Hierarchical Condition Category (HCC) payment methodology
Develops and maintains professional working relationships with Medical Providers and their staff necessary to facilitate onsite review of medical records
Maintains documents for tracking audit results, status of reviews etc
Qualification
Required
High school diploma or GED
3+ years of experience in related field
Certified Professional Coder or Certified Risk Coder
Preferred
Minimum of one year of risk adjustment experience
Familiarity with Outlook, Excel and Coding Systems
Benefits
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Company
Blue Cross NC
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way.
5001-10000 employees
H1B Sponsorship
Blue Cross NC has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (1)
2023 (2)
2022 (5)
2021 (13)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Tunde Sotunde
President and Chief Executive Officer
Caleb Davies
Medicaid Market CFO - Healthy Blue of NC Medicaid
Recent News
2026-01-06
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2025-10-31
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