Coding Quality Specialist

Centauri Health Solutions

2d • Remote

About The Position

Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange. In partnership with our clients, we improve the lives and health outcomes of the members and patients we touch through compassionate outreach, sophisticated analytics, clinical data exchange capabilities, and data-driven solutions. Our solutions directly address complex problems such as uncompensated care within health systems; appropriate, risk-adjusted revenue for specialized sub-populations; and improve access to and quality of care measurement. Headquartered in Scottsdale, Ariz., Centauri Health Solutions employs 1700 dedicated associates across the country. Centauri has made the prestigious Inc. 5000 list since 2019, as well as the 2020 Deloitte Technology Fast 500™ list of the fastest-growing companies in the U.S. For more information, visit www.centaurihs.com. Role Summary: The Coding Quality Specialist conducts coding quality reviews on internal and external coders to ensure diagnoses are appropriately and accurately assigned based upon clinical documentation, ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinic Guidance, CMS program guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Coding Quality Specialist will apply guidance provided for the medical record code abstraction primarily for Medicaid lines of business (Complete Code Capture), but may also include Medicare Advantage Risk Adjustment or Commercial Risk Adjustment.

Requirements

• Minimum of 3 recent years of production coding experience in Retrospective Risk Adjustment coding (must be within last 6 months)
• Minimum of 2 years experience conducting coder audits in the Risk Adjustment environment
• Required code set knowledge and coding experience in Medicaid (primary), Medicare, Commercial Minimum of 1 year coding experience with Complete Code Capture
• Minimum of 5 years certified with a core coding credential from AHIMA or AAPAHIMA – CCS, CCS-P, AAPC – CPC, CRC (no apprentice credentials accepted)
• Strong organizational skills
• Technical savvy with high level of competence in basic computers, Microsoft Outlook, Word, and Excel
• Strong written and verbal communication skills
• Ability to work independently in a remote environment

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 conduct education to internal and external coders based upon those findings
• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations
• Ability to pass coding quiz with 80% accuracy
• Consistently maintain a minimum 95% accuracy on audits by coding leadership
• Meet minimum productivity requirements as outlined by the project terms
• Ability to adhere to client guidelines when superseding other guidelines
• Assist coding leadership by making recommendations for process improvements to further enhance coding goals and outcomes
• Handle other related duties as required or assigned

Benefits

• We believe strongly in providing employees a rewarding work environment in which to grow, excel and achieve personal as well as professional goals.
• We offer our employees competitive compensation and a comprehensive benefits package that includes generous paid time off, a matching 401(k) program, tuition reimbursement, annual salary reviews, a comprehensive health plan, the opportunity to participate in volunteer activities on company time, and development opportunities.
• This position is bonus eligible in accordance with the terms of the Company’s plan.
• Factors which may affect starting pay within this range may include geography/market, skills, education, experience and other qualifications of the successful candidate.
• Centauri currently maintains a policy that requires several in-person and hybrid office workers to be fully vaccinated.
• New employees in the mentioned categories may require proof of vaccination by their start date.
• The Company is an equal opportunity employer and will provide reasonable accommodation to those unable to be vaccinated where it is not an undue hardship to the company to do so as provided under federal, state, and local law.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 101-250 employees