[Hiring] Professional Coder II @Horizon Blue Cross Blue Shield of New Jersey

Role Description

The Senior Professional Coder provides services to perform code abstraction using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state and federal regulations and internal policies and procedures. HCC Risk Adjustment Coders will be involved with activities of code abstraction for the following programs; including but not limited to, Commercial Risk Adjustment/IVA (Initial Validation Audit), Medicare Advantage Risk Adjustment/RADV Audit (Risk Adjustment Data Validation). HCC Risk Adjustment Coders are required to maintain a minimum 95% accuracy rating on coding quality audits.

• Compile chart review findings statistics, analyze data results and implement meaningful action plans that improve providers’ performance levels.
• Educate new staff to produce and maintain high quality data abstraction and chart reviews.
• Develop quality assurance processes to ensure data integrity of all submitted diagnoses to regulatory agencies and key stakeholders.
• Evaluate and improve the effectiveness of risk adjustment coding programs, policies & procedures and workflow.
• Work closely with inter-departmental team management to support coding initiatives related to risk adjustment programs.
• As a Subject Matter Expert, support risk adjustment coding initiatives to identify opportunities to enhance and grow business.
• Educate and keep management informed on current changes in regulations/guidance related to ICD-10 coding and quality documentation and reporting.
• Interface with operations and clinical leadership to assist in identification of coding & documentation improvements and promote best practices.
• Conduct mock audits or surveillance activities that target problematic diagnoses as identified by CMS and internal stakeholders.
• Understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.
• Review medical records for completeness, accuracy and compliance with applicable coding guidelines and regulations.
• Maintain department productivity and accuracy standards.

Qualifications

• Requires current Registered Health Information Technologies (RHIT) or a certification and in good standing by a nationally recognized accrediting agency (e.g., American Academy of Professional Coders (AAPC) or American Health Information Management (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.

Requirements

• Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding.
• Requires knowledge of medical terminology and anatomy & physiology related to medical procedures, abbreviations and terms.
• Requires knowledge of the health care delivery system.

Skills/Abilities

• Requires the ability to utilize a personal computer and applicable software (e.g. proficiency in Word and Excel).
• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.
• Must demonstrate professional and ethical business practices, adherence to company standards and a commitment to personal and professional development.
• Proven ability to exercise sound judgment and problem solving skills.
• Proven ability to ask probing questions and obtain thorough and relevant information.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision).
• Retirement Plans.
• Generous PTO.
• Incentive Plans.
• Wellness Programs.
• Paid Volunteer Time Off.
• Tuition Reimbursement.

Salary Range

$79,100 - $105,945