Lead Senior Coder QA

Reli Group•Windsor Mill, MD

1d•Onsite

About The Position

This role performs complex coding and dispute/appeal reviews, ensures compliance with RADV guidelines, provides quality assurance and feedback to coders, and serves as a subject matter expert and escalation point for coding questions. The Lead Sr. Coder also leads and supports a team of up to 15 coders, assists with training and development, and ensures established accuracy, productivity, confidentiality, and quality standards are consistently met. Perform primary and secondary coding validation review of inpatient, outpatient, and physician office medical records per Risk Adjustment Data Validation (RADV) guidelines. Perform intake evaluation include validity status of medical records and attestations, non-compliance issues, and other validations checks as required per RADV guidelines. Perform Medical Record Dispute and Appeal reviews per RADV guidelines. Perform QA of coder reviews and provide feedback and training as needed to coders Oversee team of up to 15 primary and senior coders providing guidance and answering questions Mediate coding decisions between the Senior and Primary Coders and give feedback to Coders as appropriate. Answer questions from Primary and Senior coders through the escalation process. Accurately enter data into encoder, CDAT-M, and other as required software using a personal computer, keyboard and/or mouse. Follow all established processes and procedures. Report problems to Project Director with regard to unique record or process issues. Maintain security and confidentiality of medical records and Protected Health Information (PHI). Consistently meet or exceed productivity and accuracy standards of 95% minimum IRR established by the customer and/or the Company Consistently meet attendance standards established by the Company. Interact appropriately with peers, co-workers, other Contractors, and the customer, when necessary. Contribute to building a positive team spirit. Assist Project Director with development of training materials. Assist with training of new coders. Perform other duties and projects as assigned by the Project Director.

Requirements

Must be a certified medical coder; with certification from any recognized United States medical coding credentialing institution.
A minimum of five (5) years of experience in abstracting and ICD-9/ICD-10-CM coding of general acute hospital (inpatient and outpatient) and physician medical records by applying ICD-9/ICD-10-CM Coding Guidelines for inpatient and outpatient settings and related Official Coding Clinics.
Ability to function in a lead role and/or train medical record reviewers.
Knowledge and skills to serve as “Master Coder” (i.e., gold standard) for all medical record coding projects.

Responsibilities

Perform primary and secondary coding validation review of inpatient, outpatient, and physician office medical records per Risk Adjustment Data Validation (RADV) guidelines.
Perform intake evaluation include validity status of medical records and attestations, non-compliance issues, and other validations checks as required per RADV guidelines.
Perform Medical Record Dispute and Appeal reviews per RADV guidelines.
Perform QA of coder reviews and provide feedback and training as needed to coders.
Oversee team of up to 15 primary and senior coders providing guidance and answering questions.
Mediate coding decisions between the Senior and Primary Coders and give feedback to Coders as appropriate.
Answer questions from Primary and Senior coders through the escalation process.
Accurately enter data into encoder, CDAT-M, and other as required software using a personal computer, keyboard and/or mouse.
Follow all established processes and procedures.
Report problems to Project Director with regard to unique record or process issues.
Maintain security and confidentiality of medical records and Protected Health Information (PHI).
Consistently meet or exceed productivity and accuracy standards of 95% minimum IRR established by the customer and/or the Company.
Consistently meet attendance standards established by the Company.
Interact appropriately with peers, co-workers, other Contractors, and the customer, when necessary.
Contribute to building a positive team spirit.
Assist Project Director with development of training materials.
Assist with training of new coders.
Perform other duties and projects as assigned by the Project Director.