Coder II

Job not on LinkedIn

🔥 6 minutes ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $79.1k - $105.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

👻 Ghost score 15%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Perform code abstraction using Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, state and federal regulations, and internal policies • Conduct code abstraction for Commercial Risk Adjustment/IVA and Medicare Advantage Risk Adjustment/RADV Audit programs • Maintain a minimum 95% accuracy rating on coding quality audits • Compile chart review findings statistics, analyze data results, and implement action plans to improve provider performance • Educate new staff on high-quality data abstraction and chart reviews • Develop quality assurance processes to ensure data integrity of submitted diagnoses • Evaluate and improve risk adjustment coding programs, policies, procedures, and workflows • Collaborate with inter-departmental management on risk adjustment coding initiatives • Support initiatives as a Subject Matter Expert to identify opportunities to enhance and grow the business • Keep management informed of changes in ICD-10 coding regulations, guidance, quality documentation, and reporting • Partner with operations and clinical leadership to identify coding and documentation improvements and promote best practices • Conduct mock audits or surveillance activities targeting problematic diagnoses • Translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction • Review medical records for completeness, accuracy, and compliance • Maintain department productivity and accuracy standards

🎯 Requirements

• Current Registered Health Information Technologies (RHIT) or a certification in good standing by a nationally recognized accrediting agency (e.g., AAPC or AHIMA) • 5+ years of Medical Coding experience • Minimum of 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 related to medical procedures, abbreviations and terms • Knowledge of the health care delivery system • Ability to utilize a personal computer and applicable software, including proficiency in Word and Excel • Effective verbal and written communication skills and ability to work well within a team • Professional and ethical business practices, adherence to company standards, and commitment to personal and professional development • Sound judgment and problem-solving skills • Ability to ask probing questions and obtain thorough and relevant information • Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

🏖️ Benefits

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

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