Coder II

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Execute code abstraction following Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, state and federal regulations, and internal policies.

• Carry out code abstraction for Commercial Risk Adjustment/IVA and Medicare Advantage Risk Adjustment/RADV Audit programs.

• Achieve and maintain a minimum accuracy rating of 95% on coding quality audits.

• Gather statistics from chart review findings, analyze data outcomes, and implement action plans to enhance provider performance.

• Train new staff on high-quality data abstraction and chart review methodologies.

• Create quality assurance processes to guarantee the integrity of submitted diagnoses data.

• Assess and refine risk adjustment coding programs, policies, procedures, and workflows.

• Collaborate with inter-departmental management on risk adjustment coding initiatives.

• Act as a Subject Matter Expert to recognize opportunities for business enhancement and growth.

• Keep management updated on changes to ICD-10 coding regulations, guidance, quality documentation, and reporting.

• Work alongside operations and clinical leadership to pinpoint coding and documentation improvements and advocate for best practices.

• Execute mock audits or surveillance activities focusing on problematic diagnoses.

• Convert CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.

• Examine medical records for completeness, accuracy, and compliance.

• Uphold department productivity and accuracy standards.

⛳️ Requirements

• Current Registered Health Information Technologies (RHIT) certification or a similar credential in good standing from a nationally recognized accrediting body (e.g., AAPC or AHIMA).

• Over 5 years of experience in Medical Coding.

• At least 5 years of experience in Health Insurance/quality chart audits and/or Utilization Review.

• Bachelor's degree is mandatory.

• Expertise in CPT-4, HCPC, ICD-9/ICD-10 coding.

• Familiarity with medical terminology and anatomy & physiology pertinent to medical procedures, abbreviations, and terminology.

• Understanding of the health care delivery system.

• Capability to utilize a personal computer and related software, with proficiency in Word and Excel.

• Strong verbal and written communication skills and ability to collaborate effectively within a team.

• Commitment to professional and ethical business practices, adherence to company standards, and dedication to personal and professional growth.

• Good judgment and problem-solving abilities.

• Capacity to ask insightful questions and gather thorough, relevant information.

• Candidates must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision).

• Retirement Plans.

• Generous PTO.

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.