Risk Adjustment Coding Educator

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

The Risk Adjustment Coding Educator position is focused on partnering with providers to ensure proper documentation and coding that accurately captures and supports risk adjustable conditions. This role has a solid knowledge base of the ICD-10-CM capture and will be focused on helping providers accurately code the full burden of illness for Medicare Advantage (MA) and "The Marketplace" (ACA) members. Support for providers may include but is not limited to: audits, providing internal and external education on coding rules and requirements, and travel to provider sites.

What you'll do:

• Assist Risk Adjustment leadership in developing and implementing a comprehensive BCBSNE risk adjustment provider education program.

• Perform periodic audits of providers' medical records to review and identify if codes are captured accurately. Document findings and review with department leadership for potential mitigation or correction opportunities.

• Develop and conduct educational opportunities for providers focused on coding best practices and current regulations to help promote awareness of the risk adjustment process, as well as ongoing education of coding standards.

• Act as a knowledgeable partner for providers regarding appropriate coding standards and recommend potential opportunities for improvement based on internal and external reviews and audits.

• Prepare and provide timely feedback, in collaboration with network analysts or provider experts, regarding all risk adjustment initiatives.

• Maintain current knowledge of ICD-10-CM codes, CMS HCC model and updates, CMS documentation requirements and coding guidelines, and state and federal regulations.

Candidates applying to this may be remote.Applicant for this position can live in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

To be considered for this position, you must have:

• High school diploma or equivalent.

• CRC (Certified Risk Adjustment Coder) is required, or a CPC with certification of CRC within six (6) months of hire. Note: AHIMA comparable certifications (CCA, CCS, or CDIP) will be considered. Assistance to obtain the necessary certifications will be provided for a strong candidate fit.

• 3+ years recent experience in medical record review, diagnosis coding, and/or auditing, to include experience with ICD-10-CM coding.

• Strong written and verbal communication skills.

• Experience with MS Office tools, specifically, experience with developing and presenting PowerPoint presentations.

• Ability to exceed the attendance and timeliness requirements of the department.

• Ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

An equivalent combination of education and experience may be substituted for this requirement.

The ability to meet or exceed the attendance and timeliness requirements of their departments.

The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

The strongest candidates for this position will also possess:

• Previous experience with Medicare and/or commercial risk adjustment guidelines, rules and regulations.

• Previous experience /understanding of electronic medical and health records.

• Previous experience in designing or developing education materials.

• Prior experience teaching/training others on correct coding guidelines and can present to large groups of providers/clinicians, including physicians.

• Previous risk adjustment experience.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.