Medical Coder Risk Adjustment Remote

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, thereâ??s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, youâ??ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

This position will be primarily responsible for conducting retrospective medical record reviews and validate diagnoses codes to ensure diagnoses and services are accurately coded. The Medical Coder Risk Adjustment will possess a strong desire to learn and be coached to develop efficiencies to meet production and quality standards set by the supervisor/manager. This person should demonstrate good communication skills with attention to detail, flexibility with the ability to effectively manage multiple demands concurrently with ease. This position will also support departmental efforts in identifying members with HCC conditions and facilitate efficient and effective interventions to ensure accurate and complete coding.

What you'll do:

• Thoroughly review medical records to identify and code ICD-10-CM diagnoses that map to a Risk Adjusted HCC and/or Rx HCC.
• Determine when additional documentation is required to complete the medical record review or when documentation does not support the diagnosis captured.
• Appropriately add or delete diagnosis based on medical record documentation guidelines to ensure documentation meets all CMS requirements for valid HCC Risk Adjustment submission.
• Support departmental goals and objectives.
• Collaborate with multiple departments to optimize risk adjustment efforts.

To be considered for this position, you must have:

• High School Diploma or equivalent.
• Current CPC (Certified Professional Coder) or AHIMA CCS (Certified Coding Specialist) credential is required.
• CRC (Certified Risk Coder) Certification training beginning within 6 months post hire.
• 2+ years recent experience in medical record review, diagnosis coding, and/or auditing is required.

The strongest candidates for this position will also possess:

• An associate degree from an accredited college or university.
• Experience with Medicare and/or Commercial risk adjustment process.
• Experience/understanding of electronic medical & health records.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.