CareFirst Careers

Risk Adjustment Medical Coding Specialist

Resp & Qualifications

The Risk Adjustment Coding Specialist supports the retrospective Risk Adjustment supplemental filings and the HHS-Risk Adjustment Data Validation (RADV) audit by performing moderately complex medical record review, ensuring compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines.

Under the supervision of the Supervisor, ACA Risk Adjustment the incumbent’s accountabilities may include, but are not limited to, the following:

1. Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation provided at all levels of complexity.
• Utilizes appropriate coding guidelines and recommends any changes to diagnosis codes based on chart review
• Achieves and maintains coding accuracy levels greater than 90%
• Works with vendors, providers and hospital staff to coordinate record access.

2. Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education
• Work with the Senior Risk Adjustment Coding Specialist(s) and third-party vendors to negotiate agreement on complex medical record diagnoses and determine compliance with coding guidelines which will be accepted by the federal government

3. Participate in provider education activities


Required Education and Experience:

• Associates degree in health information technology or health care related field or equivalent years of work experience.
• A minimum of three years of risk adjustment / Hierarchical Condition Category (HCC) coding experience.
• Certified Coding Specialist (CCS, CPC, CCS-P, CRC) or Registered Health Info Tech/Admin (RHIT or RHIA)
Skills and Abilities
• Intermediate knowledge of Adobe Acrobat Professional.
• Intermediate Competency Level in Microsoft Word, Excel, Outlook, Claims Processing – Facets.
• Ability to adapt to various coding technology platforms, such as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems and coding documentation platforms.
• Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. 
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.  
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

• Bachelors degree in health information technology or health care related field preferred.


Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply:

Closing Date

Please apply before: 12/3/2020

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.


The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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