Senior Risk Adjustment Coder — Data & Audit Expert

100 Horizon Healthcare Services, Inc; Newark (NJ); 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

The Senior Professional Coder at 100 Horizon Healthcare Services, Inc. performs code abstraction for ICD-9-CM/ICD-10-CM under Official Guidelines and regulatory standards. The role supports Commercial and Medicare Advantage risk adjustment audits and maintains 95% accuracy in coding quality audits.

You will mentor staff, develop QA processes, and review medical records for completeness and accuracy. Requires RHIT or AHIMA/AAPC certification and 5+ years of medical coding experience.

Qualifications

• Requires RHIT or certification by AAPC or AHIMA.
• Requires 5+ years of Medical Coding experience.
• Requires minimum 5+ years’ experience in Health Insurance quality chart audits and/or Utilization Review.
• Bachelor’s degree required.

Responsibilities

• Compile chart review findings statistics and analyze data to improve provider performance.
• Educate new staff to maintain high quality data abstraction and chart reviews.
• Develop QA processes to ensure data integrity of diagnoses reported to regulators and stakeholders.
• Evaluate and improve risk adjustment coding programs, policies and workflows.
• Collaborate with inter-departmental teams to support coding initiatives and risk adjustment projects.
• Educate management on changes in ICD-10 regulations and guidance.

Skills

Microsoft Word

Excel

Verbal communication

Written communication

Education

Bachelor's degree

RHIT certification

AAPC/AHIMA certification

Job description

The Senior Professional Coder at 100 Horizon Healthcare Services, Inc. performs code abstraction for ICD-9-CM/ICD-10-CM under Official Guidelines and regulatory standards. The role supports Commercial and Medicare Advantage risk adjustment audits and maintains 95% accuracy in coding quality audits.

You will mentor staff, develop QA processes, and review medical records for completeness and accuracy. Requires RHIT or AHIMA/AAPC certification and 5+ years of medical coding experience.