Medicare Risk Adjustment Coder

BlueCross BlueShield of South Carolina

Medicare Risk Adjustment Coder with BlueCross BlueShield analyzing Medicare Stars data and conducting medical record reviews. Responsible for compliance documentation and HEDIS accreditation activities.

Posted 4/16/2026full-timeNorth Carolina, South Carolina • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

Monitor and collect Medicare Stars data to improve health plan ratings
Conduct specific medical record reviews
Analyze findings and make recommendations for corrective actions
Prepare formal documentation for compliance with applicable standards
Perform Health Plan Employer Data Information Set data collection (HEDIS) and National Committee for Quality Assurance (NCQA) accreditation activities

Requirements

What you’ll need

Bachelor's in a job-related field
4 years job related work experience or Associate's and 2 years job related work experience
Professional certification in nursing, pharmacy, medical assistant, or other healthcare training
Certified professional in Healthcare Quality (CPHQ) or other relevant certifications
Minimum 2 years of managed care, quality improvement, medical research or clinical experience
Minimum 2 years working with HEDIS standards and Medicare Advantage
Must be familiar with clinical terminology and medical records

Benefits

Comp & perks

Subsidized health plans
Dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysismedical record reviewcompliance documentationHEDIS data collectionMedicare Stars data monitoringcorrective action recommendationsquality assuranceclinical terminologymedical researchmanaged care

Certifications

Bachelor's degreeAssociate's degreeCertified professional in Healthcare Quality (CPHQ)nursing certificationpharmacy certificationmedical assistant certification