Risk Adjustment Medical Record Coder – Senior

🔥 56 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🏥 Medical Billing and Coding

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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• Maintain compliance with CMS risk adjustment diagnosis coding guidelines • Perform comprehensive first-pass reviews of medical records and physician assessment forms for HCC coding • Assist with intake and quality assurance of medical records as necessary • Perform or participate in special projects as directed by management • Identify and capture active conditions that map to risk values • Support documentation accuracy, quality, and compliance within the Risk Adjustment & Quality Division • Collaborate remotely through team chats and support peers as needed

🎯 Requirements

• Associate's degree or equivalent work experience required; equivalent experience is defined as 2 years of professional work experience • 1 year of progressive medical coding and health care experience required • Professional coding certification from AHIMA or AAPC, such as CPC, CCS, RHIT, or RHIA • Must acquire the AAPC Certified Risk Adjustment Coder (CRC) certificate within one year after completed training • ICD-10 coding assessment required • Understanding of ICD-10 coding standards required • HCC coding experience, particularly in Medicare Advantage, ACA, and Medicaid programs, ideal • Ability to work independently with minimal supervision or function in a team environment • Proficiency in Microsoft Office: Outlook, Word, Excel, and PowerPoint • Analytical and problem-solving skills, including ability to perform non-routine analytical tasks • Ability to work as a team player, stay organized, and handle multiple projects • Excellent oral and written communication skills • Strong interpersonal and organizational skills • Comfortable working standard shift hours from 8am–5pm ET • Applicants must live in an approved U.S. state; remote hiring excludes California, Massachusetts, New Hampshire, New Jersey, and New York

🏖️ Benefits

• Remote work • Standard day shift hours, 8am–5pm ET • Training • Potential relocation assistance if required to reside in Chattanooga, TN • Remote-first work environment