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Jobs at BlueCross BlueShield of Tennessee (Now Hiring) — 17 open

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Risk Adjustment Medical Record Coder-2

Chattanooga, Tennessee, United States · Remote OK

Mid level

We are hiring a Risk Adjustment Medical Record Coder at BCBST! In this role, you will support accurate and compliant coding practices by performing first-pass reviews of member medical records to identify and capture act…

Skills: HCC Coding, ICD-10 Coding, Medical Record Review, Risk Adjustment, Medicare Advantage

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

CHOICES Care Coordinator- Memphis Area

Memphis, Tennessee, United States · Hybrid

Mid level

Are you a compassionate individual who enjoys helping others achieve their personal health and wellness goals? If so, a career as a CHOICES Care Coordinator might be perfect for you. As a Care Coordinator, you will make …

Skills: Clinical Assessment, Case Management, Time Management, Critical Thinking, Customer Service

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Supervisor Case Management

Chattanooga, Tennessee, United States · Remote OK

Senior

Our Total Health Management team is looking for a new Supervisor of Case Management! We are seeking a results-driven and people-focused Clinical Supervisor for Women and Children’s Health who is committed to strengthenin…

Skills: Case Management, Clinical Supervision, Performance Management, Coaching, Quality Auditing

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Intern - Provider Data Reporting

Chattanooga, Tennessee, United States · Remote OK

Entry level

BCBST’s BlueBridge Internship program is seeking an Intern for our Provider Network Team! About the Program: BCBST’s BlueBridge Internship Program offers hands-on experience, professional collaboration, and opportunities…

Skills: SQL Query Design, SSRS, Power BI, SSIS, Data Analysis

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Legal Assistant

Chattanooga, Tennessee, United States · Hybrid

Mid level

We are seeking a dedicated and adaptable Legal Assistant to join our team in our corporate offices in Chattanooga, TN. This office‑based role requires a true team player—someone who works well with others, is willing to …

Skills: Microsoft Office, Legal Document Preparation, Contract Formatting, Scheduling, Communication

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Behavioral Health Case Manager BlueCare Plus

Jackson, Tennessee, United States · Remote Solely

Mid level

The BlueCare team at BlueCross BlueShield of Tennessee (BCBST) is seeking a Behavioral Health Case Manager to support members enrolled in BlueCare Plus, a Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) desi…

Skills: Case Management, Care Coordination, Behavioral Health, Motivational Interviewing, Microsoft Office

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Investigator II

Nashville, Tennessee, United States · Hybrid

Senior

BCBST is hiring an Investigator II Are you an experienced investigator with a strong eye for detail and a passion for protecting the integrity of healthcare? At BlueCross BlueShield of Tennessee, our Special Investigatio…

Skills: Fraud Investigation, Evidence Analysis, Interviewing, Case Documentation, Risk Assessment

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Senior Technical Recruiter

Chattanooga, Tennessee, United States · Remote OK

Mid level

BlueCross BlueShield of Tennessee is hiring a Senior Technical Recruiter to support full-cycle recruitment across the enterprise. In this consultative role, you’ll serve as a trusted advisor to hiring managers and senior…

Skills: Full-Cycle Recruitment, Technical Sourcing, Stakeholder Management, Data-Driven Decision Making, Candidate Experience

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Supervisor, Clinical Quallity Assurance

Chattanooga, Tennessee, United States · Remote OK

Senior

We are hiring a Supervisor for Clinical Quality Assurance here at BCBST to lead a high-performing team of nurses statewide. In this role, you will guide clinical reviews of medical records, partnering with provider offic…

Skills: Clinical Leadership, Quality Improvement, Project Management, Medical Record Review, HEDIS

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Sr. Financial Systems Analyst

Chattanooga, Tennessee, United States · Remote OK

Senior

The Financial Accounting and Reporting division is looking to add a Sr. Financial Systems Analyst to our team. This role serves as a liaison between the Finance division and the IT organization to provide product and use…

Skills: Workday Financials, Cognos, Power BI, Financial Data Management, Business Process Configuration

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Data Modeler

Chattanooga, Tennessee, United States · Remote OK

Mid level

BlueCross BlueShield of Tennessee is hiring a Data Modeler. In this fully-remote role, you’ll support data modeling tasks on multiple database technologies. In your day to day, you’ll design, deliver, and govern scalable…

Skills: Data Modeling, Erwin DM, Facets, OLTP, Data Warehousing

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Clinical Review Manager

Chattanooga, Tennessee, United States · Remote OK

Mid level

The Commercial team is hiring a Clinical Review Manager to support the Commercial lines of business through BlueCross BlueShield of Tennessee. This role conducts comprehensive clinical reviews of medical service requests…

Skills: Clinical Review, Utilization Management, Medical Necessity Criteria, Care Coordination, Microsoft Office

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Principal AI Workflow Engineer

Chattanooga, Tennessee, United States · Remote OK

Senior

At BlueCross BlueShield of Tennessee, we’re building the foundation for an AI‑enabled future—one where our teams work smarter, our operations move faster, and our 3.4 million members experience a more responsive, reliabl…

Skills: Generative AI, LLM Integration, Python, Workflow Orchestration, API Integration

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

RN Case Manager (Federal Employees Program)

Chattanooga, Tennessee, United States · Remote OK

Senior

BlueCross BlueShield of Tennessee (BCBST) is seeking a skilled and compassionate Medical Case Manager to join the FEP Population Health team. This role supports members with acute care needs and chronic health conditions…

Skills: Case Management, Telephonic Member Engagement, Empathetic Listening, Problem Solving, Utilization Management

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Clinical Review Manager

Chattanooga, Tennessee, United States · Remote OK

Mid level

The Commercial team is hiring a Clinical Review Manager to support the Commercial lines of business through BlueCross BlueShield of Tennessee. This role conducts comprehensive clinical reviews of medical service requests…

Skills: Clinical Review, Utilization Management, Medical Necessity Criteria, Care Coordination, Case Management

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Corporate Pharmacy Director

Memphis, Tennessee, United States · Remote OK

Senior+

Job Responsibilities Benefit Strategy Development: Utilize clinical and analytical data to evaluate product performance and develop strategic pharmacy benefit options tailored to customer needs.Pharmacy SME Support: Serv…

Skills: Pharmacy Benefit Design, Managed Care, Clinical Compliance, Regulatory Compliance, Client Relationship Management

BlueCross BlueShield of Tennessee logoBlueCross BlueShield of Tennessee

Dual Special Needs Plan VP, BlueCare

Chattanooga, Tennessee, United States · Remote OK

Senior+

BCBST is hiring a Senior Executive Leader, BlueCare Plus D‑SNP. We’re looking for a proven leader who brings deep expertise in Medicare and Dual Special Needs Plans, along with a strong track record of driving financial …

Skills: P&L Management, Medicare Advantage, Dual Special Needs Plans, Regulatory Compliance, Strategic Planning

BlueCross BlueShield of Tennessee logo

Risk Adjustment Medical Record Coder-2

BlueCross BlueShield of Tennessee

Chattanooga, Tennessee, United States • Remote OK

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Mid level

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  • Full-time
  • associate degree, professional certificate
  • Posted 2d ago
  • Apply by Jul 1
  • ~40 hrs/week
  • Remote in United States

Responsibilities

Perform first-pass reviews of member medical records to identify and capture active conditions mapping to risk values. Ensure compliance with CMS risk adjustment diagnosis coding guidelines and support quality assurance of medical records.

Requirements

Requires an associate degree or equivalent experience and at least one year of progressive medical coding experience. Must hold a professional coding certification from AHIMA or AAPC and obtain the CRC certification within one year.

Full job description

We are hiring a Risk Adjustment Medical Record Coder at BCBST!

In this role, you will support accurate and compliant coding practices by performing first-pass reviews of member medical records to identify and capture active conditions that map to risk values. You’ll play an important role in ensuring documentation accuracy while contributing to overall quality and compliance within the Risk Adjustment & Quality Division.

You will contribute to team success by working collaboratively in a remote environment, engaging in team chats, and supporting peers as needed. Your proactive mindset and commitment to continuous learning will help you stay current in an evolving healthcare landscape while strengthening overall team capability.

To be successful in this position, you’ll bring strong attention to detail, coding expertise, and the ability to work independently. Ideal candidates will have experience in HCC (Hierarchical Condition Category) coding, particularly within Medicare Advantage, ACA programs, and Medicaid programs.

We foster a culture where innovation is encouraged. That includes using AI-enabled tools responsibly to support everyday work—guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to enhance accuracy, efficiency, and outcomes.

Note:
• This is a remote, day-shift position working standard shift hours; 8am-5pm ET
• Candidates should be comfortable working independently while maintaining strong engagement with the team

Job Responsibilities

  • Maintain compliance with CMS risk adjustment diagnosis coding guidelines.
  • Perform comprehensive 1st pass reviews of medical records and physician assessment forms (HCC coding).
  • Assist with the intake and quality assurance of medical records as necessary.
  • Perform or participate in special projects as directed by management.
  • ICD-10 Coding assessment is required.

Job Qualifications

Education

  • Associates degree or equivalent work experience required.  Equivalent experience is defined as 2 years of professional work experience.

Experience

  • 1 year - Progressive medical coding and health care experience required.

Skills\Certifications

  • Professional coding certification from AHIMA or AAPC (CPC, CCS, RHIT, RHIA).
  • Must acquire the Certified Risk Adjustment Coder (CRC) certificate from AAPC within one year, after completed training.
  • Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
  • Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint).
  • Proven analytical and problem-solving skills and ability to perform non-routine analytical tasks.
  • Must be a team player, be organized and have the ability to handle multiple projects.
  • Excellent oral and written communication skills.
  • Strong interpersonal and organizational skills.
  • Understanding of ICD-10 coding standards required.

Number of Openings Available

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Related keywords

Risk AdjustmentHCC CodingICD-10CMS GuidelinesMedicare AdvantageACAMedicaidCPCCCSRHITRHIACRCAHIMAAAPCMedical CodingHealthcare

About BlueCross BlueShield of Tennessee

LinkedInVisit site

Bringing peace of mind through better health to our customers and communities

Industry
Insurance
Company size
5,001-10,000 employees
Founded
1945
Headquarters
Chattanooga, TN
LinkedIn followers
49,593

As Tennessee's largest health plan, we've been helping Tennesseans find their own unique paths to good health for more than 70 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. Our mission is simple: peace of mind through better health. We're an independent, not-for-profit, locally governed health plan company – meaning we live and work alongside our Tennessee business customers and plan members. Our 6,000 employees across the state have built our strong reputation for integrity, excellent service and community leadership. But we are also part of the BlueCross BlueShield Association, a nationwide association of health care plans. Because of this, our plan members have access to the same quality health benefits while traveling or living out of state that they have while in Tennessee. © 2018 BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.

Offices: 1 Cameron Hill Circle, Chattanooga, TN 37402-2555, US · 65 N Danny Thomas Blvd, Memphis, TN 38103-2398, US · 3200 West End Ave., Suite 102, Nashville, TN 37203, US · 6305 Kingston Pike, Knoxville, TN 37919, US · 161 Heart Dr, Johnson City, Tennessee 37604, US

HealthWellnessFitnessInsuranceCustomer Serviceand Community OutreachHealth CareMedical
View all jobs at BlueCross BlueShield of Tennessee

About BlueCross BlueShield of Tennessee

LinkedInVisit site

Bringing peace of mind through better health to our customers and communities

Industry
Insurance
Company size
5,001-10,000 employees
Founded
1945
Headquarters
Chattanooga, TN
LinkedIn followers
49,593

As Tennessee's largest health plan, we've been helping Tennesseans find their own unique paths to good health for more than 70 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. Our mission is simple: peace of mind through better health. We're an independent, not-for-profit, locally governed health plan company – meaning we live and work alongside our Tennessee business customers and plan members. Our 6,000 employees across the state have built our strong reputation for integrity, excellent service and community leadership. But we are also part of the BlueCross BlueShield Association, a nationwide association of health care plans. Because of this, our plan members have access to the same quality health benefits while traveling or living out of state that they have while in Tennessee. © 2018 BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.

Offices: 1 Cameron Hill Circle, Chattanooga, TN 37402-2555, US · 65 N Danny Thomas Blvd, Memphis, TN 38103-2398, US · 3200 West End Ave., Suite 102, Nashville, TN 37203, US · 6305 Kingston Pike, Knoxville, TN 37919, US · 161 Heart Dr, Johnson City, Tennessee 37604, US

HealthWellnessFitnessInsuranceCustomer Serviceand Community OutreachHealth CareMedical
View all jobs at BlueCross BlueShield of Tennessee

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