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.
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
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 service skills and techniques
- Strong knowledge of HEDIS measures and their requirements
- Strong knowledge of risk adjustment/HCC coding
Required Professional Competencies
- Strong oral and written communication skills
- Ability to effectively interact with staff, customers and management at all levels
- Demonstrates flexibility and willingness to embrace change
Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.