Medical Record Specialist Remote

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

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, thereâ??s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, youâ??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: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

The Medical Review Specialist (Prospective Risk Specialist) is primarily responsible for providing support to the Risk Adjustment Department. This individual will perform a wide array of administrative tasks, such as ordering and follow up on medical records requested, attach medical records received to electronic member profile and supporting the annual audit. This individual should have experience using medical software with attention to detail to ensure medical record accuracy.

What you'll do:

• Request medical records for risk adjustment department coding review.

• Process medical records received from external providers and upload into electronic member profiles, reviewing documents to ensure medical records are complete.

• Analyze medical records to determine if documentation requires coding review.

• Obtain missing data or documents needed to complete chart review.

• Conduct provider outreach to follow up on requested medical records.

• Support the initial RADV-Risk Adjustment Data Validation audit, process yearly by screening medical records to be submitted.

To be considered for this position, you must have:

• High School Diploma and one to two (1-2) years medical office experience
• Medical Record experience or HIM certification preferred
• Proficient in medical terminology, anatomy, and physiology
• Ability to multi-task and work in multiple software systems concurrently
• Professional phone and office technology skills, familiarity with EHR systems
   

An equivalent combination of education and experience may be substituted for this requirement.

The ability to meet or exceed the attendance and timeliness requirements of their departments.

The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.
 

The strongest candidates for this position will also possess:

• CPC, CPC-A in progress or completed

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.