CPC Investigator

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 The Certified Professional Coder (CPC) is responsible for performing reviews, audits and coding oversight of medical records to ensure the appropriate CPT codes, diagnosis codes and modifiers according to Generally Accepted Medical Coding Guidelines, CPT-4; HCPCS; ICD-10 Guidelines; and, CMS Correct Coding. Also, the incumbent will complete and take appropriate action in gathering, analyzing and interpreting requisite documentation to conduct low level investigations. The incumbent will also support the investigators related to research and resolution of fraudulent activity. Manage the Special Investigations Unit pended claims to insure we are meeting SLAs and service standards associated with ASO accounts and Blue Card requirements. The incumbent will also be responsible for handling low level investigative activities (