Senior Medical Coder - Risk Adjustment (Remote)

Horizon Blue Cross Blue Shield; Newark (NJ); Remote; USD 79,000 - 106,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Professional Coder II to perform ICD-9/ICD-10 coding, CPT/HCPCS abstraction, and risk adjustment activities in a remote Newark-based role. The candidate should have RHIT or AHIMA/AAPC certification and over 5 years of medical coding experience, including health insurance/chart audits or utilization review.

The role emphasizes accuracy, compliance, and education of staff, with collaboration across departments and adherence to

Qualifications

• Requires RHIT or AHIMA/AAPC certification
• 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
• Proficiency in CPT-4, HCPC, ICD-9/ICD-10 coding
• Knowledge of medical terminology and anatomy & physiology
• Proficiency with Word and Excel; strong communication skills

Responsibilities

• Compile chart review findings, analyze data results and improve provider performance
• Educate new staff to produce high quality data abstraction and chart reviews
• Develop quality assurance processes to ensure data integrity of submitted diagnoses
• Evaluate and improve efficiency of risk adjustment coding programs and workflows
• Collaborate with cross‑functional teams to support coding initiatives
• Act as SME to identify opportunities to enhance and grow business in risk adjustment
• Educate management on changes in ICD-10 coding and documentation practices
• Interface with operations and clinical leadership to identify coding improvement opportunities
• Conduct mock audits or surveillance of diagnoses as identified by CMS and stakeholders
• Translate CPT/HCPCS/ICD-9/ICD-10 codes for HCC abstraction
• Review medical records for completeness, accuracy and compliance with coding guidelines
• Maintain department productivity and accuracy standards

Skills

CPT-4/HCPCS knowledge

MS Word

MS Excel

Verbal and written communication

Team collaboration

Problem solving

Education

RHIT or AHIMA/AAPC certification

Bachelor's degree

Tools

Word

Excel

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Professional Coder II to perform ICD-9/ICD-10 coding, CPT/HCPCS abstraction, and risk adjustment activities in a remote Newark-based role. The candidate should have RHIT or AHIMA/AAPC certification and over 5 years of medical coding experience, including health insurance/chart audits or utilization review.

The role emphasizes accuracy, compliance, and education of staff, with collaboration across departments and adherence to