Coder Quality Specialist - Remote, United States
About The Position
The Coder Quality Specialist conducts coding quality reviews of internal and external coders, ensuring diagnoses are appropriately and accurately assigned based on clinical documentation, ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinic guidance, CMS program guidance, applicable state and federal regulations, and internal policies and procedures. The role primarily applies medical-record code-abstraction guidance for Medicaid lines of business (Complete Code Capture), and may also support Medicare Advantage Risk Adjustment or Commercial Risk Adjustment. The specialist reviews medical records, reports audit findings, and educates coders based on those findings. The role requires maintaining coding and regulatory knowledge, meeting audit accuracy and productivity requirements, following client guidelines when they supersede other guidance, and recommending process improvements. The position is remote and based in the United States.
Requirements
- At least 5 years certified with a core coding credential from AHIMA or AAPAHIMA (CCS or CCS-P) or AAPC (CPC or CRC); apprentice credentials are not accepted.
- At least 3 recent years of production coding experience in Retrospective Risk Adjustment coding, within the last 6 months.
- At least 2 years of experience conducting coder audits in the Risk Adjustment environment.
- Coding knowledge and experience in Medicaid (primary), Medicare, and Commercial.
- At least 1 year of coding experience with Complete Code Capture.
- Strong organizational skills.
- Technical competence with basic computers, Microsoft Outlook, Word, and Excel.
- Strong written and verbal communication skills.
- Ability to work independently in a remote environment.
- Ability to pass a coding quiz with 80% accuracy.
Responsibilities
- Perform coding quality reviews of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
- Provide formal reports on audit findings and educate internal and external coders based on those findings.
- Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.
- Maintain at least 95% accuracy on audits conducted by coding leadership.
- Meet minimum productivity requirements as outlined by project terms.
- Adhere to client guidelines when they supersede other guidelines.
- Assist coding leadership by recommending process improvements to enhance coding goals and outcomes.
- Handle other related duties as required or assigned.
Benefits
- Comprehensive medical, dental, vision, and prescription coverage.
- Wellness program supporting overall well-being.
- Company-paid basic life and AD&D insurance.
- 401(k) plan with company match.
- Tuition reimbursement opportunities.
- Paid time off for vacation and illness.
- Six paid company holidays.
- Floating holiday.
- Company-paid training and computer equipment.
- Performance-based bonus program.
- Paid time off for volunteer activities.
- Employee referral bonus program.
- Career development and training opportunities, including leadership growth.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
