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SalaryTo learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click
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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.
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Job Summary
The Medicare Risk Adjustment Coding Specialist accurately reviews, interprets, audits, codes and analyze medical record documentation for diagnosis accuracy, correct documentation, and Hierarchical Coding Condition (HCC) abstraction, which may include inpatient, outpatient treatment and/or professional medical services, according to ICD-10 CM coding guidelines and Risk Adjustment model regulations. This incumbent will provide coding education to providers and clinical staff in accordance to the established CDI/Risk Adjustment programs and train physicians and other providers on diagnosis documentation accuracy issues. Requirements
EDUCATION
High School Diploma or equivalent
Associate's degree or two (2) years (48 semester hours) in college level coursework in business, healthcare or related field. In lieu of degree, three (3) years' medical coding experience will be considered.
Associate's degree or two (2) years (48 semester hours) in college level coursework in business, healthcare or related field. In lieu of degree, three (3) years' medical coding experience will be considered.
LICENSING/CERTIFICATION
Certified Coding Specialist (CCS) through American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) required.
Certified Risk Adjustment Coder (CRC) certification preferred.
Certified Risk Adjustment Coder (CRC) certification preferred.
EXPERIENCE
Minimum four (4) years' medical office, healthcare claims processing, medical record documentation and coding requirements experience OR two (2) years of Medicare Risk Adjustment Coding
Extensive knowledge of ICD-10, CPT and HCPCS coding.
Extensive knowledge of ICD-10, CPT and HCPCS coding.
Medicare experience required.
ESSENTIAL SKILLS & ABILITIES
Oral & Written Communication
Analyzing Data
Working Independently
Confidentiality
Medical Coding
Risk Management
Medical Record Audits
Facilitation
Sound Judgement and Decision Making
Problem solving analyzes
Highly Organized
High Integrity
Analyzing Data
Working Independently
Confidentiality
Medical Coding
Risk Management
Medical Record Audits
Facilitation
Sound Judgement and Decision Making
Problem solving analyzes
Highly Organized
High Integrity
Proficiency using Microsoft Office: Excel, Outlook, Word, and Power Point
Ability and willingness to travel.
Skills
Responsibilities
Assists with chart retrieval and other administrative documentation maintenance and reporting responsibilities., Coordinates and conducts process audits to ensure compliance with internal policies and procedures and existing CMS regulations. 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 regulation., Coordinates and facilitates training sessions for internal staff and providers on data analysis findings, solutions, and recommendations. Functions as the subject matter expert on coding review/guidelines and documentation, Facilitates and supports education activities for both internal and external stakeholders., Performs other duties as assigned., Supports the collection and distribution of documentation and coding improvement tools for designated practices, as applicable., Willingness to travel locally with limited overnight stays, estimated 50%. Certifications
Certified Professional Coder (CPC) - AAPC Security 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
Regular ADA 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.
