Government Programs Risk Adjustment Coder

2 days ago

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

💵 $63.4k - $119.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

🦅 H1B Visa Sponsor

Apply Now

Receive Emails with Similar Jobs

Capital Blue Cross

WebsiteLinkedInAll Job Openings

Healthcare Insurance • Finance • B2C

Capital Blue Cross is a health insurance company that offers a range of health plans for individuals, families, and employers. They serve customers in Central Pennsylvania and the Lehigh Valley, focusing on providing health coverage services such as Medicare plans, student health plans, and resources for managing medical care. Capital Blue Cross positions itself as a partner in health, emphasizing support for members' overall wellness and preventive health measures.

1001 - 5000 employees

Founded 1938

⚕️ Healthcare Insurance

💸 Finance

👥 B2C

📋 Description

• Perform comprehensive reviews of medical records to ensure compliance with CMS and departmental risk adjustment guidelines • Conduct chart audits to identify undocumented or underreported chronic conditions • Collaborate with internal teams and external stakeholders to support accurate diagnosis capture and improve clinical documentation • Maintain productivity and accuracy benchmarks, ensuring all diagnosis coding is accurate, complete, specific, and appropriate • Stay current on risk adjustment policies, HCC updates, and official coding guidelines

🎯 Requirements

• 3 years' experience with CMS-HCC and HHS-HCC risk adjustment coding • Proficiency in ICD-10-CM coding with a strong focus on risk adjustment and HCC coding methodologies • Thorough knowledge of the CMS Medicare risk algorithm (CMS HCC) and the ACA risk algorithms (HHS HCC) and coding guidelines • Certified Risk Adjustment Coder (CRC) credential required • High School Diploma or GED • Proficient with common EMR systems e.g., Allscripts, EPIC, AthenaHealth, PracticeFusion, Medent

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Generous time off including Paid Time Off, Holidays, and Volunteer time off • Incentive Plan • Tuition Reimbursement • Professional development and training opportunities