Risk Adjustment Coding Oversight Specialist

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.

BCBSNE is happy to offer three work designations for our Omaha area employees: in-office, hybrid, and remote.
If choosing to work remote, this role can be located in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

The Risk Adjustment Coding Oversight Specialist is responsible for conducting vendor oversight and quality assurance audits for risk adjustment purposes. This includes conducting oversight chart audits and internal quality assurance of risk adjustment projects. This role requires good communication skills with attention to detail, flexibility, and ability to manage multiple demands concurrently with ease. This position will facilitate efficient and effective interventions to ensure accurate and complete coding.

What you'll do:

• Conduct quality oversight audits pertaining to risk adjustment coding of both internal and external (vendor) coders.

• Appropriately report added or deleted diagnosis based on medial record review results.

• Report QA findings and trends to Sr Coding Oversight specialist and/or manager.

• Support departmental goals and vendor SLA requirements

• Perform additional risk adjustment projects as needed

To be considered for this position, you must have:

• High-school Diploma or equivalent
• Current CPC (Certified Professional Coder) or AHIMA CCS (Certified Coding Specialist) credential is required.
• Current CRC (Certified Risk Coder) Certification.
• Minimum of two (2+) years recent experience in medical record review, risk adjustment, diagnosis coding and/or quality auditing is required.

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:

• An Associates degree from an accredited college or university.
• Experience with Medicare and/or Commercial risk adjustment process.
• Experience/understanding of electronic medical & health records.
• Experience conducting quality assurance reviews.

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.