Medical Coding Reviewer - Risk Adjustment

Job Summary

As a Risk Adjustment Coder, you will work independently in a remote environment and collaborate with our team to ensure accuracy and quality in our diagnosis coding work. We offer the opportunity to work with a dynamic team in a remote environment

Competitive salary and benefits package

Professional growth and development opportunities

If you are a motivated and detail-oriented coding professional looking for a new challenge,

Under the direction of the Sr. Manager Risk Adjustment Audit, the Risk Adjustment Coder is responsible for reviewing medical records to apply appropriate diagnosis coding in compliance with International Classification of Diseases, Tenth Revision (ICD-10) coding guidelines for the purposes of risk adjustment.

• Review inpatient and/or outpatient medical records to identify and assign relevant diagnosis codes using ICD-10 classification systems to ensure accuracy and compliance of risk adjustment. This may be in the form of ad hoc projects, provider quality audits, vendor overreads or RADVs.
• Review and validate provider-submitted and/or vendor-submitted medical record documentation and ICD-10 diagnosis codes to identify and correct any inaccuracies or discrepancies to ensure accuracy and compliance of risk adjustment.
• Responsible for meeting production targets while adhering to strict quality audit accuracy of 95%.
• Provide non-production level support by documenting coder observations that would not otherwise be captured through the diagnosis coding.
• Assist Provider Educator during audit results presentation with provider groups by answering diagnosis coding questions.
• Administrative duties including updating SOPs, DTPs and other related documents.
• Participating in process improvement initiatives such as but not limited to coding tool enhancements.

• 2+ years related work experience

• High school diploma or GED

• Required active Certified Professional Coder American Association of Professional Coders CPC and/or CCSP OR (AAPC) or American Health information Management Association (AHIMA)

• Ability to work independently in a remote work environment.

• Proficient with ICD-10-CM Guidelines for coding and reporting.

• Previous work experience in production-based environment.

• Strong understanding of medical terminology, abbreviations, body systems/anatomy, physiology and concepts of disease processes.

• Intermediate level of Microsoft Office proficiency (Word, Excel, Outlook, PowerPoint).

• CRC - Certified Risk Adjustment Coder from American Association of Professional Coders (AAPC)

• Coding or auditing experience in a Provider Group, Outpatient coding setting or Health Plan. Knowledge of Medicare Advantage and/or Affordable Care Act (ACA-Commercial) programs.

• Organizational skills, working effectively in a multi-task-based environment, and with an ability to work both independently and collaboratively.

• Sedentary work:
  Exerting up to 10 pounds of force occasionally to move objects.

• Jobs are sedentary if traversing activities are required only occasionally.

As a Florida Blue employee, you will be at the heart of Guide Well’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, short- and long-term disability programs
• Leave programs to support personal circumstances
• Retirement Savings Plan including employer match
• Paid time off, volunteer time off, 10 holidays and 2 well-being days
• Additional…