Risk Adjustment QA Coordinator

2 weeks ago

Chattanooga, United States BlueCross BlueShield of Tennessee Full time

Performs quality assurance activities on risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS).Job Description:Job ResponsibilitiesPerform comprehensive 2nd pass reviews of medical records, prospective assessments, physician assessment forms (PAFs) and medical claims in accordance with CMS risk adjustment diagnosis coding guidelines.Maintain compliance with CMS risk adjustment diagnosis coding guidelines through identification of HCC adds and deletes.Assist with the intake and quality assurance of medical records as necessary.Perform or participate in special projects as directed by management.Job QualificationsEducationAssociates degree in related healthcare field or equivalent years of experience. Equivalent years of experience are defined as one year of professional experience for every year of college requested.Experience1 year - Progressive medical coding and health care experience required.Skills/CertificationsProfessional coding certification from AHIMA or AAPC (CPC, CCS, RHIT, RHIA) .Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.Demonstrated presentation and team facilitation skills.Proficient in MicroSoft Office (Outlook, Word, Excel, Access and PowerPoint).Accuracy and attention to detail.Capacity to solve problems and manage multiple assignments with critical deadlines.Excellent oral and written communication skills.Strong interpersonal and organizational skills.Strong analytical skills.Positive attitude, self-driven, engaging, proactive, results drive.Must have exceptional Quality and Productivity performance.Understanding of ICD-10 coding standards required.Must acquire the Certified Risk Adjustment Coder (CRC) certificate from AAPC within one year, after completed training.Job Specific Requirements: Preferred Skills:Number of Openings Available:1Worker Type:EmployeeCompany:BCBST BlueCross BlueShield of Tennessee, Inc.Applying for this job indicates your acknowledgement and understanding of the following statements:BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:BCBST's EEO Policies/NoticesBlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means. Tobacco-Free Hiring StatementTo further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results. Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.

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