Blue Cross and Blue Shield of Nebraska is looking for a Medical Coder Risk Adjustment to join our mission-driven organization. In this role, you will be responsible for retrospective medical record reviews and validating diagnosis codes to ensure diagnoses and services are accurately captured, supporting our efforts to champion the health and well-being of our members.
What You'll Do
- Thoroughly review medical records to identify and code ICD-10-CM diagnoses that map to a Risk Adjusted HCC and/or Rx HCC.
- Determine when additional documentation is required to complete a review or when documentation does not support a captured diagnosis.
- Appropriately add or delete diagnoses based on medical record documentation guidelines to ensure compliance with all CMS requirements for valid HCC Risk Adjustment submission.
- Support departmental goals and objectives.
- Collaborate with multiple departments to optimize risk adjustment efforts.
What We're Looking For
- High School Diploma or equivalent.
- Current CPC (Certified Professional Coder) or AHIMA CCS (Certified Coding Specialist) credential.
- CRC (Certified Risk Coder) Certification training beginning within 6 months post hire.
- 2+ years recent experience in medical record review, diagnosis coding, and/or auditing.
Nice to Have
- An associate degree from an accredited college or university.
- Experience with Medicare and/or Commercial risk adjustment processes.
- Experience or understanding of electronic medical and health records.
We strongly believe that diversity of experience, perspective, and background leads to a better workplace for our employees and a better product for our customers and members.
