Senior Professional Coder

2 weeks ago

Newark, United States Horizon BCBS Full time

Job 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 regulations, federal regulations, internal policies, and internal 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, Medicare Advantage Risk Adjustment, Commercial IVA (Initial Validation Audit), and Medicare RADV (Risk Adjustment Data Validation). HCC Risk Adjustment Coders are required to maintain minimum 95% accuracy on coding quality audits.
Responsibilities:

• Compile chart review findings statistics, analyze data results and implement meaningful action plans that improve providers’ performance levels
• Education 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 work flow
• Work closely with inter-departmental team management to support coding initiatives related to risk adjustment programs
• As a Subject Matter Expert, this person will support risk adjustment coding initiatives to identify opportunities to enhance and grow business
• Responsible for educating and keeping 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
• Can 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.
• Maintains department productivity and accuracy standards.
Qualifications:
• Requires current Registered Health Information Technologies (RHIT) or Certified Professional Coder designation from the American Academy of Professional Coders or a Certified Coding Specialist , P from the American Health Information Management (AHIMA)
• Requires 3-5+ years of Medical Coding experience
• Requires a minimum of 3-5+ years’ experience in Health Insurance/quality chart audits and/or Utilization Review.
• Bachelor's degree required
Requires Risk Adjustment coding
Knowledge
Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding
Requires knowledge of medical terminology 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

Disclaimer
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.
Additional Skills: Extensive risk adjustment experience and must have effective verbal and written communication skills

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