Job Summary
As a Risk Adjustment Coder, you will work independently in a remote environment
and collaborate with our team to ensure accuracy and quality in our diagnosis
coding work. We offer the opportunity to work with a dynamic team in a remote
environmentCompetitive salary and benefits packageProfessional growth and
development opportunitiesIf you are a motivated and detail-oriented coding
professional looking for a new challenge, apply today!
Under the direction of the Sr. Manager Risk Adjustment Audit, the Risk
Adjustment Coder is responsible for reviewing medical records to apply
appropriate diagnosis coding in compliance with International Classification of
Diseases, Tenth Revision (ICD-10) coding guidelines for the purposes of risk
adjustment.
What You'll Be Doing
Review inpatient and/or outpatient medical records to identify and assign
relevant diagnosis codes using ICD-10 classification systems to ensure
accuracy and compliance of risk adjustment. This may be in the form of ad hoc
projects, provider quality audits, vendor overreads or RADVs.
Review and validate provider-submitted and/or vendor-submitted medical record
documentation and ICD-10 diagnosis codes to identify and correct any
inaccuracies or discrepancies to ensure accuracy and compliance of risk
adjustment.
Responsible for meeting production targets while adhering to strict quality
audit accuracy of 95%.
Provide non-production level support by documenting coder observations that
would not otherwise be captured through the diagnosis coding.
Assist Provider Educator during audit results presentation with provider
groups by answering diagnosis coding questions.
Administrative duties including updating SOPs, DTPs and other related
documents.
Participating in process improvement initiatives such as but not limited to
coding tool enhancements.
What We Require
2+ years related work experience
High school diploma or GED
Required active Certified Professional Coder American Association of
Professional Coders CPC and/or CCSP OR (AAPC) or American Health information
Management Association (AHIMA)
Ability to work independently in a remote work environment.
Proficient with ICD-10-CM Guidelines for coding and reporting.
Previous work experience in production-based environment.
Strong understanding of medical terminology, abbreviations, body
systems/anatomy, physiology and concepts of disease processes.
Intermediate level of Microsoft Office proficiency (Word, Excel, Outlook,
PowerPoint).
What We Prefer
CRC - Certified Risk Adjustment Coder from American Association of
Professional Coders (AAPC)
Coding or auditing experience in a Provider Group, Outpatient coding setting
or Health Plan. Knowledge of Medicare Advantage and/or Affordable Care Act
(ACA-Commercial) programs.
Organizational skills, working effectively in a multi-task-based environment,
and with an ability to work both independently and collaboratively.
General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move
objects.
Jobs are sedentary if traversing activities are required only occasionally.
What We Offer
As a Florida Blue employee, you will be at the heart of GuideWell’s vision – to
lead the nation in transforming health through compassionate, connected, and
technology-enabled care that delivers personalized value and empowered living.
To support your wellbeing, comprehensive benefits are offered. As an employee,
you will have access to:
Medical, dental, vision, life and global travel health insurance
Income protection benefits: life insurance, short- and long-term disability
programs
Leave programs to support personal circumstances
Retirement Savings Plan including employer match
Paid time off, volunteer time off, 10 holidays and 2 well-being days
Additional voluntary benefits available; and a comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws.
Benefits may vary based on the state in which work is performed. Benefits for
intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as
opportunities for incentive or commission compensation. We also conduct regular
annual reviews with pay for performance considerations for base pay increases.
Typical Hourly Offer/Pay Range: $28 - $34
Hourly Pay Range: $28 - $45
Final pay will be determined with consideration of market competitiveness,
internal equity, and the job-related knowledge, skills, training, and experience
you bring.
We are an Equal Employment Opportunity employer committed to cultivating a work
experience where everyone feels like they belong and can perform at their best
in pursuit of our mission. All qualified applicants will receive consideration
for employment.