Medical & Healthcare - CW Risk Adjustment Coder

Job Description

POSITION PURPOSE

This position is responsible for ongoing risk adjustment improvement activities Under general supervision this position includes ongoing quality improvement activities to ensure the organization’s Risk Adjustment programs are implemented and meet all government requirements.

NATURE AND SCOPE

This role does not manage people

This job reports to : Departmental Leadership Necessary Contacts : In order to effectively fulfill this position, the incumbent must be in contact with :

All levels of BCBSLA personnel; physicians and their office personnel; hospitals and allied health provider administration, personnel and third-party medical record vendors; other Blue Plans; Client Association and contracted vendors.

QUALIFICATIONS

Education

High School Diploma or GED required

Work Experience

years of medical coding experience required with experience in risk adjustment preferred

year medical coding audit experience preferred Skills and Abilities Knowledge base of clinical standards of care, preventive health standards and Risk Coding.

Ability to evaluate medical records with attention to detail Knowledge of ICD- Guidelines Ability to understand CMS Risk Adjustment guidelines Must have the ability to travel up to % Licenses and Certifications

CRC, CPC or CCS required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS Under limited supervision review and assess documentation and accurately translate chronic conditions into the appropriate diagnosis code from inpatient and outpatient medical records Enter coding results into database Maintain % coding accuracy on all coding projects Perform second level coding review to ensure accuracy and limit fraud, waste, and abuse Monitor submission for coding trends and provide feedback to coders regarding coding errors and trends Perform annual coding and documentation training to staff and providers Disperse Risk Adjustment Gap report to providers and facilities Other duties may be assigned to meet the needs of the organization Additional Accountabilities and Essential Functions The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

Perform other job-related duties as assigned, within your scope of responsibilities.

Job duties are performed in a normal and clean office environment with normal noise levels.

Work is predominately done while standing or sitting.

The ability to comprehend, document, calculate, visualize, and analyze are required.

Release Comments : limit candidates' submission. Prefer candidates live in Louisiana. This position will be remote. Equipment has not been confirmed if it will be provided by Louisiana Blue. REMOTE POSITION - if candidate does not live in Louisiana be sure to list their location in the comments

EEO :