Clinical Quality Coder II

This is a fully remote position, open to applicants in Arizona, +22 more states.

📋 Description

• Review outpatient medical records utilizing ICD-10-CM, CPT, Medicare Advantage, and CMS coding and reporting guidelines.

• Carry out medical record evaluations to guarantee the precise assignment of medical diagnoses and procedures.

• Perform pre-appointment assessments of each relevant encounter, including those related to Medicare Advantage.

• Ensure the correct reporting of diagnoses.

• Notify physicians of potential clinical conditions that may necessitate further review.

• Assist in validating risk adjustment codes for CMS and HHS Risk Adjustment models.

⛳️ Requirements

• High School Diploma or General Education Diploma (GED).

• CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA or AAPC Coding Certification (CCS-P, CPC, COC, or CPC-P).

• At least one (1) year of recent relevant experience with CMS-HCC and HHS-HCC risk adjustment coding, encompassing the review of pediatric and OB/GYN diagnoses and associated documentation requirements.

• Extensive knowledge of ICD-10 diagnosis coding conventions and standards.

• Familiarity with Medicare Advantage Coding Program/HCC and Quality Coding Program requirements.

• Understanding of medical terminology and abbreviations related to diseases, illnesses, and injury processes.

• Proficient in the use of grouper software and/or coding reference materials to assign and validate diagnosis codes.

• Awareness of National Correct Coding Initiative edits, Coding Clinic, CPT Assignment coding guidelines, and medical record contents.

• Capability to work independently as well as collaboratively within a team while managing multiple tasks in a busy environment.

• Proven written and verbal communication abilities to convey sensitive information clearly and professionally.

🏝️ Benefits

• Comprehensive benefits package for eligible positions.

• Full-time regular employee status.

• Monday–Friday schedule.

• No weekend requirements.