Senior HCC Risk Adjustment Coder | Impact & Compliance Pro

Horizon Health Care Inc; United States; On-site; USD 79,000 - 106,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Professional Coder to perform ICD-9/ICD-10 code abstraction in line with Official Coding Guidelines and regulatory requirements. The role supports Commercial and Medicare Advantage risk adjustment activities with a target accuracy of 95%.

The ideal candidate holds RHIT or AHIMA/AAPC certification and has 5+ years in medical coding and health-insurance chart audits. Strong collaboration and data accuracy are essential for success.

Qualifications

• Requires RHIT or certification by AAPC or AHIMA
• Requires 5+ years of Medical Coding experience
• Requires 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.
• Educate new staff to maintain high quality data abstraction and chart reviews.
• Develop QA processes to ensure data integrity of diagnoses for regulatory agencies.
• Evaluate and improve risk adjustment coding programs, policies and workflow.
• Collaborate with inter-departmental teams to support coding initiatives.
• Educate management on changes in ICD-10 coding and quality documentation.
• Interface with operations and clinical leadership to promote best practices.
• Conduct mock audits or surveillance activities targeting problematic diagnoses.
• Understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.
• Review medical records for completeness, accuracy and compliance.

Skills

Word/Excel

Verbal and written communication

Professional and ethical conduct

Sound judgment

Probing questions

Education

Bachelor's degree

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Professional Coder to perform ICD-9/ICD-10 code abstraction in line with Official Coding Guidelines and regulatory requirements. The role supports Commercial and Medicare Advantage risk adjustment activities with a target accuracy of 95%.

The ideal candidate holds RHIT or AHIMA/AAPC certification and has 5+ years in medical coding and health-insurance chart audits. Strong collaboration and data accuracy are essential for success.