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Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.
Arkansas Blue Cross is only seeking applicants for remote positions from the following states:
Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.
Job Summary
The Medical Risk Adjustment Coder reviews, interprets and codes medical record documentations according to ICD-10 CM coding guidelines and risk adjustment model regulations. This position supports Payer-Provider program relations by reviewing member medical record data and sharing results with Risk Adjustment and Provider Education teams.Requirements
EDUCATION
Bachelor’s degree in Business, Healthcare, or related field. In lieu of degree, five (5) years’ experience in healthcare, medical office management, insurance risk adjustment, medical coding and/or claims processing will be considered. (Completion of college level courses in medical terminology, anatomy and physiology, and pathophysiology highly desirable.)
LICENSING/CERTIFICATION
Current Certified Coding Specialist (CCS or CCS-P), Certified Coding Associate (CCA), Certified Professional Coder (CPC or CPC-A), OR Certified Risk Coder (CRC) certification.
EXPERIENCE
Previous experience in medical coding, medical claims review and/or claims processing desirable.
Knowledge of Medicare and Affordable Care Act guidelines and regulations.
Proficiency in ICD-10 CM coding guidelines.
Experience working with Hierarchical Coding Condition (HCC) and Risk Adjustment Factor (RAF) preferred.
ESSENTIAL SKILLS & ABILITIES
ICD Coding
CPT Codes
Oral & Written Communication
Microsoft Office
Analyzing Data
Working Independently
Confidentiality
Skills
• Analytical Problem Solving• Business Compliance• Collaborative Communications• Continued Learning• Critical Thinking• Cross-Functional Communications• Cross-Functional Planning• Customer Relationship Management (CRM)• Data Analysis• Educational Development• Microsoft Office• Oral Communications• Time Management• Training and Development• Written CommunicationResponsibilities
• Analysis/Coding: Reviews, interprets and codes medical record documentation for diagnosis accuracy, correct documentation, and Hierarchical Coding Condition (HCC) abstraction. This may include inpatient treatment, outpatient treatment, and/or professional medical services according to ICD-9/10-CM coding guidelines and risk adjustment model regulations• Documentation: Supports the collection and distribution of documentation and coding improvement tools for designated practices, as applicable. Creates and/or maintains documentation for processes related to job role• Other duties: As assigned• Process Improvement: Actively participates and engages in program improvement discussions and activities• Willingness to travel for professional training, estimated 5%Certifications
Certified Professional Coder (CPC) - AAPCSecurity Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
RegularADA Requirements
1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.
