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Risk Adjustment Coding and Outreach Speciallist

Blue Cross Blue Shield of Kansas

Topeka, Kansas(remote)

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JOB DETAILS
SKILLS
Analysis Skills, Auditing, Billing, Centers for Medicare and Medicaid Services (CMS), Claims Processing, Clinical Study Publications, Coding Standards, Content Management Systems (CMS), Data Quality, Dental Insurance, Department of Health and Human Services, Detail Oriented, Documentation, Federal Laws and Regulations, Fitness, Healthcare Software, ICD-10, Incentive Programs, Maintain Compliance, Medical Coding, Medical Diagnosis, Medical Records, Medicare, Natural Language Processing (NLP), Natural Language Software, Performance Metrics, Production Systems, Quality Metrics, Record Keeping, Requirements Validation/Verification, Risk, Risk Management, Team Player, Training Program, Training/Teaching, Vision Plan
LOCATION
Topeka, Kansas
POSTED
1 day ago
Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

You Belong At Blue

Why Join Us?

  • Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  • FamilyComes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
  • Professional Growth Opportunities: Advance your career with ongoing training and development programs.
  • Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
  • Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
  • Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

  • Base compensation is only one component of your competitive Total Rewards package
    • Incentive pay program (EPIP)
    • Health/Vision/Dental insurance
    • 6 weeks paid parental leave for new mothers and fathers
    • Fertility/Adoption assistance
    • 2 weeks paid caregiver leave
    • 401(k) plan matching up to 5%
    • Tuition reimbursement
    • Health & fitness benefits, discounts and resources

Job Summary

Under the direction of the Supervisor, Risk Adjustment Coding and Outreach, this position will be responsible for the ICD-10-CM diagnosis code capture for Affordable Care Act (ACA) and Medicare Risk Adjustment initiatives to include CMS required Medicare and Commercial Risk Adjustment and Risk Adjustment Data Validation (RADV) audits. The responsibilities of this position significantly impact the company's risk adjustment revenue opportunities. This position will retrieve, review, and analyze medical records for documentation to substantiate the medical diagnosis codes submitted on claims. Activities also include member and provider communication and education, scheduling, and process performance measurement to support closing both risk adjustment and quality care gaps. This position is in a fast-paced, developing area.

"This position is eligible to work remote, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

What you'll do

  • Ensures compliance with all applicable Federal, laws and regulations related to coding and documentation guidelines for Commercial and Medicare Risk Adjustment Payment System.
  • Performs medical record review to capture of all relevant diagnosis codes included in the CMS and HHS Hierarchical Condition Categories (HCC) conditions for Commercial and Medicare Risk Adjustment Payment system.
  • Abstract diagnostic data and properly assign ICD-10-CM codes for both health Hierarchical Condition Categories (HCC) and Rx HCCs that map to a Risk Adjusted HCC ensuring the documentation meets all CMS standard requirements for valid HCC Submission.
  • Selects and accurately records all appropriate records and data on assigned chart abstraction projects.
  • Utilize medical coding software programs to abstract, analyze, and/or evaluate clinic documentation and enter diagnosis codes.
  • Comply with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, and compliance with Risk adjustment production standards
  • Must meet 95% coding accuracy within 6 months and maintain accuracy in conjunction with department coding production guidelines.
  • Research and review provider submitted claims though Imaging resources.
  • Ability to learn and understand Natural Language Processing software (NLP).

What you need

Education and Experience:

  • High school diploma or equivalent is required
  • AAPC or AHIMA coding certification required
  • Risk adjustment HCC coding experience is preferred
  • One year of experience to include coding, billing, claims auditing

Knowledge/Skills/Abilities
  • Extensive knowledge of and ICD-10CM coding guidelines.
  • Ability to consistently meet established minimum coding quality standards in a production environment.
  • Ability to assimilate and adapt quickly and accurately to coding guideline and/or other job-related changes.
  • Requires close attention to detail, strong grammar and reading comprehension skills, along with strong crit

About the Company

B

Blue Cross Blue Shield of Kansas

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