Senior HCC Risk Adjustment Coder

Horizon Blue Cross Blue Shield of New Jersey; United States; On-site; USD 79,000 - 106,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Tuition reimbursement

Volunteer time off

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a Senior Professional Coder to perform ICD-9-CM/ICD-10-CM coding, ensure compliance with guidelines and regulations, and support risk adjustment initiatives. The role requires 5+ years of medical coding, RHIT or professional certification, and a bachelor’s degree.

You will review records, educate staff, and develop QA processes to maintain data accuracy and regulatory compliance across commercial and Medicare programs.

Qualifications

• Requires RHIT or certification by a recognized accrediting body (e.g., AAPC or AHIMA).
• Requires 5+ years of Medical Coding experience.
• Requires a minimum of 5+ years' experience in Health Insurance/quality chart audits and/or Utilization Review.
• Bachelor's degree required

Responsibilities

• Compile chart review findings statistics, analyze data results and implement action plans to improve providers' performance.
• Educate new staff to produce high quality data abstraction and chart reviews.
• Develop quality assurance processes to ensure data integrity of submitted diagnoses to regulatory agencies and stakeholders.
• Evaluate and improve risk adjustment coding programs, policies & procedures and workflow.
• Interface with operations and clinical leadership to assist in identification of coding and documentation improvements.

Education

RHIT Certification

AAPC/AHIMA Certification

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a Senior Professional Coder to perform ICD-9-CM/ICD-10-CM coding, ensure compliance with guidelines and regulations, and support risk adjustment initiatives. The role requires 5+ years of medical coding, RHIT or professional certification, and a bachelor’s degree.

You will review records, educate staff, and develop QA processes to maintain data accuracy and regulatory compliance across commercial and Medicare programs.