HEDIS Abstractor - RHIA/Coder

Job ID:JP00044064

Anticipated Start Date: 01/02/24

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for contract workers (via BCforward) who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Candidate will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base. If necessary, the medical record review is conducted on site in provider office or hospital institution. Local travel may be required. This candidate will be required to handle a high volume of telephonic interaction with provider offices. Candidates must follow up on requested medical records with providers. Must keep excellent documentation of research and contact information. Candidate must pass a medical record abstraction test prior to starting actual record reviews.

Primary duties may include, but are not limited to:

• This is a high production environment and candidates must adhere to measured productivity requirements, module testing and at times retesting to meet minimum requirements.
• Required to perform research on internal claims systems.
• Sharing of department responsibilities as assigned.
• Must be flexible and willing to develop and share strategies to accomplish goals.
• Work under the supervision of Anthem internal staff and designated lead in order to achieve goals and keep the project moving.
• Reviews require data analysis and research within the Anthem data systems.
• Candidates must have critical thinking skills as they will conduct research in a thoughtful and methodical search in order to locate specific claim information.
• Research includes all resources provided in order to find best information.
• Examples of deep dive research would be based on Anthem specific platforms (i.e. Immunization registries, local claims system membership and defaulted claim information).
• Candidates must have excellent skill set to read and interpret physician handwriting.
• Candidates must live within an acceptable commuting distance and reliable transportation is required.
• Work attire is professional casual.
• Responsible for determining appropriate codes for medical services and procedures to ensure accurate adjudication of claims.
• Reviewing operative notes and various forms and medical records to identify proper coding of claims.
• Provides training and guidance to service operations staff to ensure accurate claims adjudication and explanation of benefits.
• Reviews denied claims and advises service staff regarding appeals.
• Maintains current knowledge of coding and keeps current with medical compliance and reimbursement policies impacting claims payment.

Preferred

• Experience with Cotiviti is helpful but not required.
• Experience working remotely is highly preferred.

Requirements:

• High School graduate with RHIA/RHIT certification in a clinical practice or medical coding, review or provider reimbursement auditing or equivalent work experience of at least 2 yrs will be considered.
• Works under the direction of a HEDIS Lead as a crossover position from abstractor to researcher.
• Candidates must have prior experience with research and either HEDIS measures or auditing data submitted as claims.
• Candidates must have computer skills and analysis capabilities in order to navigate CPT4 code and ICD9 and ICD10 DX based on HEDIS Technical Specification requirements.
• Candidates must have an understanding of codes for services based on diagnosis and procedure.
• They must be research and detail oriented with the tenacity to find claim specific data for a specific measure within a given period of time.
• Additional technical education or associate degree desired.
• Knowledge of Microsoft office is required.
• Requires effective research, written, oral, and interpersonal communication skills.
• Candidates must have basic Excel skills and must have the ability to type 30-40 WPM.
• Prior HEDIS experience a plus
• Requires CPC (Certified Professional Coder) with designation from an accredited source such as American Health Information Management Association, American Academy of Professional Coders, or Practice Management Institute.

Job Type: Contract

Additional Details:

• Monday-Friday, 8:00 am to 4:30 pm in their local time zone

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.