Blue Cross and Blue Shield of Kansas City · 4 hours ago
Risk Adjustment Coder
United States
Full-time
Remote
Mid Level
3+ years expBlue Cross and Blue Shield of Kansas City is committed to providing health, financial, and lifestyle benefits for a best-in-class employee experience. The Risk Adjustment Coder will develop expert knowledge of CMS models to ensure data accuracy and improve clinical coding programs, while also performing detailed reviews and providing support for coding education.
Association
Responsibilities
Reviews medical record and claims information to identify all appropriate coding based on Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC & HHS-HCC) models
Provides real time support and coordination visiting Primary Care Providers and Care Coordinators for Commercial Risk Adjustment coding education
Develops policies and procedures for system, application and related operational processes in order to ensure optimization and compliance with CMS risk adjustment and Star measurement coding guidelines
Abstract all risk adjusted diagnosis codes from acceptable provider documentation and in accordance with industry standards for coding and reporting
Adheres to current industry standard, as defined in the ICD-10 guidelines for coding and reporting
Conducts Provider queries for any documentation inconsistencies within client electronic medical record and/or other query system
Confirms accurate entry of risk adjusted codes into proprietary software or database as defined by project and client scope
Must be able to maintain 95% accuracy and completeness in ongoing quality assurance reviews as required by internal QA policy
Uses expert knowledge of CMS-HCC & HHS-HCC Risk Adjustment Model to provide support in forecasting care opportunities within Commercial risk adjustment and Medicare Advantage segments, coding of Diagnosis codes that pertain to HCCs
Provides encounter data reconciliation between CMS and health plan claims detail to ensure accurate risk adjustment payments
Additional duties as necessary to meet CMS guidelines and regulations
Develops and shares guidelines/best practices with internal risk adjustment coders to improve coding documentation techniques
May develop policies and procedures for system, application and /or related operational processes in order to ensure optimization and compliance with CMS risk adjustment and Star measurement coding guidelines
May pull medical records for our risk adjustment/HEDIS/STARS projects
Helps with special projects within our Risk Adjustment Operations group
Qualification
Required
Bachelor's degree in business administration or Bachelor of Science in Nursing (BSN), health administration, or related field or an equivalent combination of education and experience
3 years of medical coding experience in a healthcare plan or environment
2 years of experience working in medical information environment (ex. At health plan, provider office, hospital, etc.)
CPC (Certified Professional Coder) or Equivalent
Must obtain CRC within one year of employment
Preferred
2 years of risk adjustment coding experience
Experience with MS Excel and MS Project
Risk Adjustment program experience
ICD-10 Proficiency
CRC (Certified Risk Adjustment Coder)
Benefits
Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
Annual incentive bonus plan based on company achievement of goals
Time away from work including paid holidays, paid time off and volunteer time off
Professional development courses, mentorship opportunities, and tuition reimbursement program
Paid parental leave and adoption leave with adoption financial assistance
Employee discount program
Company
Blue Cross and Blue Shield of Kansas City
Blue Cross and Blue Shield of Kansas City (Blue KC) is an independent licensee of the Blue Cross Blue Shield Association and a not-for-profit health insurance provider serving more than one million members in 32 counties in greater Kansas City and northwest Missouri and Johnson and Wyandotte counties in Kansas.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Erin Stucky
President and CEO
Amber Mustard
Chief Technology Officer
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