Risk Adjustment Coding and Outreach Specialist

Blue Cross and Blue Shield of Kansas is looking to add to our Risk Adjustment team and has an opportunity for a Risk Adjustment Coding and Outreach Specialist. 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 hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

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Why Join Us?

• Family Comes First: Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities.
• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Stability: 80 years of commitment, compassion, and community
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.

Compensation

$26.34 - $31.30

Non-exempt Grade 13

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid.  All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

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

• High school diploma or equivalent is required.
• AAPC or AHIMA coding certification required.
• Two years of medical coding is required.
• 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 critical thinkin