Certified Coding Specialist II | Part-Time WFH

Community Hospice & Palliative Care•Jacksonville, FL

10d•Hybrid

About The Position

The Certified Coding Specialist II reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid, and private insurance reimbursement. This position serves as an advanced coding subject matter expert, supports provider education, performs audits, supports risk adjustment initiatives, and may assume departmental leadership in the absence of the Medical Coding Manager.

Requirements

Certified Professional Coder (CPC) required
Certified Risk Adjustment Coder (CRC) required
Current Florida Driver’s License (acceptable driving record)
AHCA Level 2 Background Screening (eligible status required)
Associate degree preferred
Coding program or CPC prep required
3–5 years coding experience required
Advanced CPT, ICD-10-CM, HCPCS, and E/M coding proficiency
Strong understanding of CMS regulations, HCC/risk adjustment, and MIPS
Strong auditing and analytical skills
Provider education and communication skills
Microsoft Office (advanced Excel preferred)
Strong organizational and critical thinking skills
Ability to manage multiple priorities and work independently

Nice To Haves

Experience with auditing and provider education preferred
Experience with risk adjustment/HCC coding strongly preferred
Experience in Hospice, Palliative Care, ASC, or value-based programs preferred
Leadership or mentoring experience preferred

Responsibilities

Reviews, analyzes, abstracts, and translates provider documentation to assign accurate CPT, HCPCS, E/M, and modifier codes.
Reviews, analyzes, abstracts, and sequences of ICD-10-CM diagnosis codes.
Identifies and captures applicable Hierarchical Condition Categories (HCCs), chronic conditions, and risk-adjusted diagnoses in accordance with CMS and payer-specific guidelines.
Performs HCC (Hierarchical Condition Category) risk adjustment coding activities for PACE (Program of All-Inclusive Care for the Elderly), Advanced Illness Program (AIP), and other applicable organizational programs.
Provides coding support for Hospice, inpatient and outpatient Palliative Care, Alivia Supportive Care (ASC), Chronic Care Management (CCM) GUIDE, and future organizational programs.
Extracts MIPS quality measures and other value-based reporting elements from provider documentation.
Queries providers when documentation is incomplete, ambiguous, or insufficient for coding, compliance, or quality reporting.
Conducts coding-related audits including prospective audits for Palliative Care, GUIDE, and other programs to ensure documentation accuracy, coding integrity, and risk adjustment capture.
Identifies high-performing providers who may qualify for temporary audit exemption based on sustained documentation accuracy while continuing periodic monitoring.
Develops, implements, and delivers provider documentation education for physicians and Advanced Practice Registered Nurses (APRNs), including: Orientation and annual training, One-on-one education in clinical settings, Identification of documentation improvement opportunities, Monitoring effectiveness through follow-up audits, Reporting outcomes to leadership.
Serves as a coding and compliance subject matter expert for Certified Coding Specialist I staff and providers.
Works closely with Charge Entry and Billing teams to ensure timely and accurate charge submission.
Reviews Additional Documentation Requests (ADRs) and payer audit requests from Medicare, Medicaid, and commercial payers.
Assists with development of weekly and monthly departmental reports (coding, audit, productivity, and compliance).
Maintains knowledge of CMS regulations, coding guidelines, payer policies, NCCI edits, and reimbursement requirements.
Supports compliance, revenue integrity, and quality improvement initiatives.
Provides mentoring and support to Certified Coding Specialist I staff.
In the absence of the Medical Coding Manager, assumes departmental oversight includes workflow coordination and staff supervision as assigned.
Performs special projects and other duties supporting Medical Coding, Compliance, and Revenue Cycle operations.