Risk Adjustment Coder

Company: Blue Cross and Blue Shield of Kansas City
Location: Kansas City
Posted on: June 24, 2022

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