Risk Adjustment Coder
Company: Blue Cross and Blue Shield of Kansas City
Location: Kansas City
Posted on: June 24, 2022
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Job Description:
Are you interested in learning about healthcare professions and
the latest healthcare innovations in the KC area? Become part of an
organization that is dedicated to making a difference in both your
career and community.Job Description Summary : Develops expert
knowledge of the Centers for Medicare and Medicaid Services (CMS)
Commercial Risk Adjustment and Medicare Advantage Rating models in
order to develop best practices for clinical coding programs within
our risk adjustment initiatives. In addition to ensuring the
accuracy, quality, and integrity of the data gathered and submitted
to CMS, this person will perform detailed and complex review of
organizational programs in order to evaluate risk score and star
measure outcomes and identify improvement opportunities.Job
Description 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) modelsProvide real time support and coordination visiting
Primary Care Providers and Care Coordinators for Commercial Risk
Adjustment coding educationDevelops 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 guidelinesAbstract all risk adjusted
diagnosis codes from acceptable provider documentation and in
accordance with industry standards for coding and
reporting.Adherence to current industry standard, as defined in the
ICD-10 guidelines for coding and reporting.Conduct Provider queries
for any documentation inconsistencies within client electronic
medical record and/or other query systemConfirm 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
HCCsProvides encounter data reconciliation between CMS and health
plan claims detail to ensure accurate risk adjustment
paymentsAdditional duties as necessary to meet CMS guidelines and
regulationsMinimum Qualifications:Bachelor's degree in business
administration or Bachelor of Science in Nursing (BSN), health
administration, or related field or any combination of experience
providing the types and levels of knowledge and skills required by
the job3 years' prior medical coding experience in a healthcare
plan or environment; or any combination of education and experience
providing the types and levels of knowledge, skills, and abilities
required by the jobCertified Professional Coder Apprentice or
Certified Professional CoderMinimum two years' experience working
in medical information environment (ex. At health plan, provider
office, hospital, etc.)Must obtain CRC within one year of
employmentPreferred Qualifications:Certified Professional Coder or
Certified Risk Coder2+ years' experience of risk adjustment
codingExperience with MS Excel and MS ProjectRisk Adjustment
program experience preferredICD-10 ProficiencyCRC (Certified Risk
Adjustment Coder)
Keywords: Blue Cross and Blue Shield of Kansas City, Kansas City , Risk Adjustment Coder, Other , Kansas City, Kansas
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