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H
Coder II
Horizon Connect @ Wall BCBSNJ. 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 .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medical Coding, including proficiency in CPT-4, HCPC, and ICD-9/ICD-10 coding, while maintaining high accuracy standards. Capable of conducting thorough chart reviews and audits, implementing quality assurance processes, and collaborating effectively with clinical leadership to enhance coding practices.
Highest-signal resume keywords
Registered Health Information Technician (RHIT)Medical Coding ExperienceCPT-4 Coding ProficiencyICD-9/ICD-10 Coding ProficiencyHealth Insurance Quality Audits
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
ICD-9-CM CodingICD-10-CM CodingCPT CodingHCPC CodingData AnalysisChart ReviewQuality Assurance ProcessesRisk Adjustment CodingMedical TerminologyAnatomy & Physiology Knowledge
Soft Skills
Effective CommunicationTeam CollaborationProblem-SolvingSound JudgmentProfessional Ethics
Tools & Technologies
Microsoft WordMicrosoft ExcelCoding Software
Certifications & Qualifications
Registered Health Information Technician (RHIT)AAPC CertificationAHIMA Certification
Industry Keywords
Health Care Delivery SystemRisk Adjustment ProgramsQuality Chart AuditsUtilization ReviewCoding Guidelines
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement