Risk Adjustment Coding Auditor in Eagan, Minnesota at Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.
Blue Cross and Blue Shield of Minnesota

Position Title: Risk Adjustment Coding Auditor
Location: Remote
Career Area: Customer Service/Operations
About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

Blue Cross and Blue Shield of Minnesota is hiring a Risk Adjustment Coding Auditor. The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise.

An ideal candidate has 5+ years of risk adjustment coding experience and an active CRC certification. This is a production-based role requiring comfort in a high-volume environment.

Your Responsibilities

• Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices
• Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements
• Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting
• Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider‑reported diagnosis codes based on medical record documentation
• Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories
• Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements
• Contributes to audit and production efforts to meet business demand and workload priorities
• Provide written and verbal guidance on coding errors to others
• Meets audit deliverables within established timelines and deadlines
• Assists with special projects such as risk mitigation reviews
• Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment

Required skills and experiences:

• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• 5+ years of HCC coding experience in utilizing inpatient and outpatient coding guidelines
• 5+ years of experience auditing Risk Adjustment records
• 1+ years working in a Production environment
• CRC (Certified Risk Coder) in good standing, in addition to required coding certification or ability to obtain certification within the first 6 months of hire.
• Intermediate level of knowledge in risk adjustment Medicare, ACA Commercial and Medicaid models
• Demonstrated ability to apply critical thinking skills to coding policy interpretation and implementation.
• Experience providing written and verbal guidance on coding errors and trends
• Intermediate (or higher) MS Office (Word, Excel, Powerpoint & Outlook)
• Excellent organizational ability to manage multiple projects and perform in a deadline driven environment
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred skills and experiences

• Bachelor's degree
• HEDIS/STARS experience
• Provider education experience
• Prior RADV experience
• CPMA or other coding credentials

Compensation and Benefits:

Pay Range: $31.48 - $39.35 - $47.22 Hourly

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

Role Designation

Remote

Teleworker

Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.
Equal Employment Opportunity Statement

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.