Risk Adjustment Medical Record Coder

The Risk Adjustment & Quality Division at BCBST is seeking a skilled Risk Adjustment Medical Record Coder to support delivering accurate and compliant coding practices.

You will perform first-pass reviews of member medical records to identify and capture active conditions that map to risk values. This is a remote, day-shift position with flexibility to work up to 8 additional hours per week in accordance with BCBST policy.

Preferred Qualifications:

• CRC (Certified Risk Adjustment Coder) certification is a plus; if not certified, you must obtain it within one year of hire.
• Strong expertise in HCC (Hierarchical Condition Category) coding, with experience in Medicare Advantage (MA) and Affordable Care Act (ACA) programs highly preferred.

Key Attributes:

• Self-motivated and proactive, thriving in a remote work environment.
• Team player ready to engage in team chats and support colleagues.
• Eager to learn and adapt in a constantly evolving industry.

Job Responsibilities:

• Maintain compliance with CMS risk adjustment diagnosis coding guidelines.
• Perform comprehensive first pass reviews of medical records and physician assessment forms (HCC coding).
• Assist with intake and quality assurance of medical records.
• Participate in special projects as directed.
• ICD-10 coding assessment required.

Qualifications:

• Associate's degree or equivalent (2 years professional experience).
• Minimum 1 year progressive medical coding and healthcare experience.
• Professional coding certification from AHIMA or AAPC (CPC, CCS, RHIT, RHIA).
• Must obtain Certified Risk Adjustment Coder (CRC) certificate within one year.
• Ability to work independently or in a team environment.
• Proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint).
• Strong analytical and problem-solving skills.
• Excellent communication, interpersonal, and organizational skills.
• Understanding of ICD-10 coding standards required.

Number of openings: 1.

Equal opportunity employer committed to diversity and inclusion.

BlueCross BlueShield of Tennessee does not accept unsolicited assistance from search firms without valid agreements.