Clinical Quality Coder II

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

📋 Description

• Review outpatient medical records in accordance with ICD-10-CM, CPT, Medicare Advantage, and CMS coding and reporting standards.

• Execute medical record assessments to guarantee correct assignment of medical diagnoses and procedures.

• Perform pre-appointment evaluations for all relevant encounters, including those under Medicare Advantage.

• Ensure precise reporting of diagnoses.

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

• Assist in the validation of risk adjustment codes for both 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).

• A minimum of one (1) year of recent relevant experience with CMS-HCC and HHS-HCC risk adjustment coding, including the review of pediatric and OB/GYN diagnoses and associated documentation needs.

• Advanced understanding of ICD-10 diagnosis coding conventions and requirements.

• Familiarity with Quality Coding Program standards, including the Medicare Advantage Coding Program/HCC.

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

• Proficient in using 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 the contents of a medical record.

• Capability to work independently as well as collaboratively within a team.

• Ability to manage multiple tasks in a setting with potential interruptions.

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

🏝️ Benefits

• Comprehensive benefits package.

• Total rewards program.

• Full-time regular employee status.

• Monday–Friday work schedule.

• Day shift.

• No weekend obligations.