Senior Risk Adjustment Coder - ICD-10 Expert

Horizon Blue Cross Blue Shield of New Jersey; 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

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Professional Coder to perform code abstraction using ICD-9-CM/ICD-10-CM guidelines, AHA guidance, and regulatory rules. You will support risk adjustment coding initiatives, ensuring high accuracy and compliance across commercial and Medicare programs.

You will educate staff, develop QA processes, and collaborate with cross-functional teams to improve coding quality, documentation, and performance, while advancing risk adjustment

Qualifications

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

Responsibilities

• Compile chart review findings and analyze data to improve provider performance.
• Educate new staff to maintain high-quality data abstraction and reviews.
• Develop QA processes to ensure data integrity for regulatory reporting.
• Evaluate and improve risk adjustment coding programs, policies and workflows.
• Collaborate with inter-departmental teams to support coding initiatives.
• Serve as SME to identify opportunities to enhance risk adjustment business.
• Educate management on changes in ICD-10 coding guidance and documentation.
• Interface with operations and clinical leadership to promote best practices.
• Conduct mock audits to target diagnoses flagged by CMS and stakeholders.
• Review medical records for completeness and regulatory compliance.

Skills

Medical coding expertise

Data analysis

Communication skills

Team collaboration

Education

RHIT certification / AAPC / AHIMA credential

Bachelor's degree

Tools

Word

Excel

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Professional Coder to perform code abstraction using ICD-9-CM/ICD-10-CM guidelines, AHA guidance, and regulatory rules. You will support risk adjustment coding initiatives, ensuring high accuracy and compliance across commercial and Medicare programs.

You will educate staff, develop QA processes, and collaborate with cross-functional teams to improve coding quality, documentation, and performance, while advancing risk adjustment