Risk Adjustment Senior Coding and Outreach Specialist
Blue Cross Blue Shield of Kansas

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

You Belong At Blue

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
• Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
• Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package
  • Incentive pay program (EPIP)
  • Health/Vision/Dental insurance
  • 6 weeks paid parental leave for new mothers and fathers
  • Fertility/Adoption assistance
  • 2 weeks paid caregiver leave
  • 401(k) plan matching up to 5%
  • Tuition reimbursement
  • Health & fitness benefits, discounts and resources

Job Summary

The Risk Adjustment Senior Coding and Outreach Specialist is responsible for performing advanced, complex, and audit sensitive risk adjustment coding and quality activities in support of Affordable Care Act (ACA), Medicare Advantage (MA), and Risk Adjustment (RA) Programs. This role serves as a subject matter expert in CMS risk adjustment methodologies, ICD-10-CM coding, and documentation requirements, operating with a high degree of autonomy and professional judgement to ensure coding accuracy, compliance, and audit readiness. The Senior Coder identifies, assesses, and mitigates coding and documentation risk, partners closely with leadership, and makes independent decisions that directly impact RAF accuracy, audit outcomes and regulatory compliance.

"This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

What you'll do

• Act as an SME in retrospective CMS Commercial and MA risk adjustment coding, including HCC mapping, ICD-10-CM guidelines, and documentation standards.
• Lead and support daily retrospective coding operations, monitoring productivity, quality, and data integrity while prioritizing work based on regulatory risk and audit exposure.
• Ensure accurate validation of diagnosis codes submitted through EDPS and EDGE processes, exercising professional judgment in complex or non?standard scenarios.
• Conduct quality assurance reviews of internal and vendor coding, providing feedback to improve coding accuracy and consistency and reduce downstream audit risk.
• Educate and mentor junior coders and CDI staff, including review of work product, feedback on accuracy, and guidance on complex coding scenarios, without formal supervisory responsibility.
• Research and resolve complex coding scenarios using official ICD-10-CM guidelines, CMS guidance, and approved coding resources defending coding decisions as needed in audit or leadership review contexts.
• Track, analyze, and document audit results to identify trends, risks, and opportunities for process improvement and coder education.
• Identify and support initiatives to enhance claims coding accuracy, documentation quality, and risk score integrity.
• Collaborate with chart retrieval teams, data analytics, project managers, and leadership to support retrospective Risk Adjustment project goals and timelines.
• Ensure compliance with HIPAA, CMS audit protocols, and all applicable regulatory and organizational requirements.
• Promote a culture of compliance, integrity, and audit defensibility, ensuring all coding activities meet regulatory and organizational standards.

What you need

Education and Experience:

• High school diploma or equivalent required
• Active professional coding credential CRC required
• Minimum of 4 years of experience in Coding or Risk Adjustment required
• Advanced knowledge of ICD-10-CM coding, HCC models, and CMS risk adjustment regulations required
• Proven experience managing and prioritizing high-volume workloads required
• Proficiency with electronic health records (EHRs) and risk adjustment coding tools required
• Experience conducting quality audits and providing feedback or education preferred
• 2+ years' Experience in Risk Adjustment Coding preferred
• 1+ year of leadership experience preferred
• Familiarity with CMS audits (RADV), internal audits, or compliance reviews preferred

Knowledge/Skills/Abilities:

• Expert knowledge of CMS Commercial, ACA, and Medicare Advantage retrospective Risk Adjustment methodologies, including HCC models
• Advanced proficiency in ICD-10-CM coding guidelines, conventions, and official CMS coding guidance
• Deep understanding of Risk Adjustment documentation standards, including M.E.A.T. criteria and face-to-face requirements
• Strong ability to perform detailed coding quality audits and identify documentation, coding, and compliance gaps with downstream audit implications.
• Experience analyzing audit results, error trends, and productivity metrics to recommend corrective actions and process improvements
• Ability to research and resolve complex or ambiguous coding scenarios using authoritative resources (CMS, AHA, Coding Clinic)
• Knowledge of RADV audit processes, extrapolation risk, and audit defense best practices
• Understanding of encounter data submission, validation edits, and downstream impacts on RAF scores
• Proficiency in EHR systems and Risk Adjustment coding, audit, and analytics tools
• Effective written and verbal communication skills, including the ability to clearly present complex coding, audit, and risk adjustment information and provide clear feedback and education to coders, providers, vendors, and leadership.
• Strong organizational and time-management skills with the ability to manage multiple priorities in a deadline-driven environment
• Strict adherence to HIPAA, CMS audit protocols, compliance standards, and organizational policies
• Participate in provider education initiatives by identifying documentation gaps and contributing to targeted feedback, training materials, or coding tip sheets.

Compensation

$30.96 - $38.70
Non-exempt Grade 14

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.

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