Risk Adjustment Auditor/Coder

Your Day to Day

• Perform medical record reviews which include coding, abstracting and analyzing inpatient, outpatient and/or professional medical records using ICD-10 coding guidelines.
• Follows the Official ICD-10 guidelines for Coding and Reporting and has a complete understanding of these guidelines, as well as other official guidance such as CMS guidelines and AMA Coding Clinics.
• Ensure that all ICD-10 diagnoses are reported in accordance with CMS payment and Risk Adjustment guidelines.
• Consistently meet daily productivity expectations while maintaining a pre-determined level of coding quality and accuracy.
• Actively participate in internal / external meetings and training activities.
• Provide feedback and trending to leaders. Participate in special projects and other activities associated with the Risk Adjustment program as needed.
• Some travel to Massachusetts will be required as determined by leadership for onsite training and team collaboration.

We're Looking For:

• Advanced knowledge of ICD-10 CM official coding guidelines, including the use of AHA Coding Clinic or similar authoritative resources.
• Excellent oral and written communication skills
• Ability to work independently in a fast-paced environment
• Ability to interact with management personnel and the provider community
• Possess strong organizational skills and attention to detail
• Adaptive and flexible to new ideas and change

What You Bring:

• CPC coding certification from the AAPC or CCS from AHIMA required; CRC required within the first year of employment.
• 2-4 years risk adjustment coding experience required
• Expert knowledge of medical terminology and abbreviations and disease, illness and injury processes
• Working knowledge of CMS/HHS risk adjustment models required
• Associate's degree or higher preferred
• Knowledge of Microsoft Office, including Word and Excel

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.