Professional Coder

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About the Role

This position is accountable for accurately reviewing, interpreting, auditing, coding and analyzing medical record documentation for quality and the validity of diagnostic reporting, and the abstraction of risk adjusted conditions. Review may include inpatient, outpatient treatment and/or professional medical services, according to ICD-9/ICD-10 CM coding guidelines and risk adjustment model regulations. This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV), along with the annual Risk Adjustment life cycle for the Medicare, Medicaid, and Commercial lines of business.

What You'll Do

• 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.

• Identify, compile and code member/patient data, using ICD-9/ICD 10-CM and other standard classification coding systems.

• Support the collection and distribution of documentation and coding improvement tools for designated practice units as applicable.

• Support educational activities for internal stakeholders as necessary as subject matter expert on coding review/guidelines.

• Actively participate & engage in program improvement discussions and activities.

• Maintains department productivity and accuracy standards.

• Perform other related tasks as assigned.

What You Bring

Education/Experience:

• High School Diploma/GED required.

• 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 2 - 5 years of Medical Coding experience

• Requires a minimum of 2 years' experience in Health Insurance/quality chart audits and/or Utilization Review.

• Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding.

• Requires knowledge of medical terminology and anatomy & physiology related to of medical procedures, abbreviations and terms.

• Requires knowledge of the health care delivery system.

Skills and 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.

Why Horizon?

At Horizon, you'll do meaningful work that directly improves lives-while being supported by a missiondriven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we'd love to hear from you!

Salary Range:

$70,500 - $94,395

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

Salary : $70,500 - $94,395