Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.

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 four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote. If choosing to work remote, this role can be located in one of the following states: Colorado, Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

The Quality Coder for Risk Adjustment is responsible for conducting all activities involving quality assurance audits and compliance for the
Commercial Risk Adjustment team (CRA). This includes conducting quality chart audits and maintaining a formal assessment program and feedback for individual staff members and processes. The candidate must possess strong written and oral communication as week as interpersonal skills. Strong critical thinking, problem solving, attention or detail and organizational skills with a growth mindset.

What you'll do:

• Conducts quality audits pertaining to risk adjustment HCC-Hierarchical Condition Categories for coding accuracy and compliance in an objective, systematic, unbiased manner for Risk submission.
• Implements and provides feedback and guidance on quality audit assessments with peer-to-peer clinical judgement in an objective, systematic, unbiased manner.
• Create and maintain quality and production results to provide ongoing updates to supervisor/manager.
• Oversees training for new hires and existing coders on departmental workflows/processes and systems.
• Serves as a resource for the department on risk adjustment or HCC coding related questions.
• Educates the risk adjustment coding team regarding trends in quality review, existing and updated coding guidelines, ICD-10 coding changes, Coding Clinic updates.
• Maintains and updates internal risk adjustment coding policy guidelines pertaining to HCC coding guidelines.
• Maintains and updates effective department workflows and processes related to risk adjustment.

• Responsible for leading the annual RADV-Risk Adjustment Data Validation Audits with IVA vendor, including but not limited to attending meetings, correspondence between the IVA vendor and BCBS, chart review and HCC abstraction, obtaining attestation, writing summaries related to chronic conditions, coder to coder review with the IVA vendor.

• Provides support to the supervisor/manager on risk adjustment trends, reviews data to better understand trends and benchmarks.
• Medicare Risk Adjustment coding quality review oversight as needed.

To be considered for this position, you must have:

• Current CPC (Certified Professional Coder) or AHIMA CCS (Certified Coding Specialist) credential is required.
• Current CRC (Certified Risk Coder) Certification
• Minimum of 5+ years recent experience in medical record review, risk adjustment, diagnosis coding, and/or quality auditing is required.
• Experience conducting quality reviews and providing feedback in a positive, constructive, detailed fashion.

The strongest candidates for this position will also possess:

• Bachelor's degree

• CPMA Certification

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.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans