HCC Coder - Remote AZ

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This remote work opportunity requires residency, and work to be performed, within the State of Arizona. PURPOSE OF THE JOB The Coder Specialist is to perform medical record reviews and abstract highest specificity codes effectively from medical records based on the documentation provided. This data is sent to CMS to determine accurate risk adjustment factor used to adjust payments for members' future healthcare cost. Medical record reviews will be retrospective and must be conducted by a certified medial coder. Codes will be sequenced and assigned by documentation in the medical record which most accurately describes each documented diagnosis. The coder is responsible for ensuring diagnosis codes selected come from a face to face visit with a valid Risk Adjustable provider. The diagnosis must be coded according to International Classification of Diseases (ICD) version 9 or 10 depending on date of service for coding and reporting. REQUIRED QUALIFICATIONS Required Work Experience 3 years of coding experience Required Education High-School Diploma or GED in general field of study Required Licenses N/A Required Certifications Certified as CPC, CPC-I, COC, CRC, CCS, CCS-P, CPMA or RHIT PREFERRED QUALIFICATIONS Preferred Work Experience 3 years of coding experience; Clinical and HCC experience Preferred Education Clinical training (Medical Assistant, Registered Nurse, Licensed Practical Nurse, or Certified Nursing Assistant) Preferred Licenses N/A Preferred Certifications N/A ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES Comprehensive understanding of Coding guidelines/rules, regulations and methodology Accurately and efficiently conduct medical record review/ data abstraction Communicate documentation inefficiencies to Clinical Correlations team Position is expected to be 70% remote with capability to travel into the office when required for meetings/education, or travel to visit network providers to provide trending coding education Must have comprehensive understanding of the contents of a typical medical chart, medical terminology and abbreviations, ICD 9 / ICD 10 coding conventions and guidelines, what constitutes adequate substantiation of a diagnosis, and appropriate providers, documents and facilities for proper code capture Complete coding quality and accuracy maintaining industry standard of 95% or better in QA audits. Communicate effectively and professionally with care provider offices, clinics, hospitals, other clinical facilities and Medicaid Business Segment staff Maintain coding certification and keep up to date on industry changes Abide by all HIPAA and associated patient confidentiality requirements Analyze data and report to Management any inaccuracy of claims data to the best of coders knowledge Provide feedback to Clinical Correlations and Manager on education needs identified Perform all other duties as assigned The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements undefined REQUIRED COMPETENCIES Required Job Skills Knowledge of anatomy and physiology/major disease processes/pharmacology Knowledge of understanding etiology, pathology, signs and symptoms, diagnostic studies and treatment modalities Knowledge of CMS and Commercial Health Plans Strong customer servi #J-18808-Ljbffr Blue Cross Blue Shield of AZ