Job Information
Blue Cross Blue Shield of Kansas Risk Adjustment Coding and Outreach Specialist in Topeka, Kansas
This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13183889
Blue Cross and Blue Shield of Kansas is looking to add to our Risk Adjustment team and has an opportunity for a Risk Adjustment Coding and Outreach Specialist. This position will be responsible for the ICD-10-CM diagnosis code capture for Affordable Care Act (ACA) and Medicare Risk Adjustment initiatives to include CMS required Medicare and Commercial Risk Adjustment and Risk Adjustment Data Validation (RADV) audits. The responsibilities of this position significantly impact the company\'s risk adjustment revenue opportunities. This position will retrieve, review, and analyze medical records for documentation to substantiate the medical diagnosis codes submitted on claims. Activities also include member and provider communication and education, scheduling, and process performance measurement to support closing both risk adjustment and quality care gaps. This position is in a fast-paced, developing area.
This position is eligible to work hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.
Why Join Us?
- Family Comes First: Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave.
- Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities.
- Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
- Stability: 80 years of commitment, compassion, and community
- Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.
What youll do
- Ensures compliance with all applicable Federal, laws and regulations related to coding and documentation guidelines for Commercial and Medicare Risk Adjustment Payment System.
- Performs medical record review to capture of all relevant diagnosis codes included in the CMS and HHS Hierarchical Condition Categories (HCC) conditions for Commercial and Medicare Risk Adjustment Payment system.
- Abstract diagnostic data and properly assign ICD-10-CM codes for both health Hierarchical Condition Categories (HCC) and Rx HCCs that map to a Risk Adjusted HCC ensuring the documentation meets all CMS standard requirements for valid HCC Submission.
- Selects and accurately records all appropriate records and data on assigned chart abstraction projects.
- Utilize medical coding software programs to abstract, analyze, and/or evaluate clinic documentation and enter diagnosis codes.
- Comply with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, and compliance with Risk adjustment production standards
- Must meet 95% coding accuracy within 6 months and maintain accuracy in conjunction with department coding production guidelines.
- Research and review provider submitted claims though Imaging resources.
- Ability to learn and understand Natural Language Processing software (NLP).