Coding Quality Specialist

This is a fully remote position, open to applicants in Texas.

📋 Description

• Conducts thorough evaluations of physician clinical documentation across inpatient and outpatient medical records.

• Executes quality analyses to verify diagnostic and procedural coding, ensuring adherence to official coding guidelines and rules.

• Establishes appropriate payment methodologies and reimbursement processes.

• Creates case-specific written justifications to articulate and share findings with hospitals, providers, medical directors, and peer review teams.

• Performs coding re-reviews based on coding conventions and sequencing guidelines.

• Recognizes clinical inquiries and escalates cases to the Medical Director when necessary.

• Addresses provider inquiries for the resolution of appeals.

• Reviews updates from Coding Clinics, coding newsletters, and other professional references.

• Engages in continuous in-service training programs related to coding or clinical education.

• Detects and interprets patterns indicative of potential fraud or abuse, referring them for further assessment and corrective measures.

• Performs periodic peer reviews.

• Adheres to all relevant policies and standards.

• Undertakes additional responsibilities as assigned.

⛳️ Requirements

• Must possess authorization to work in the U.S. without requiring employment-based visa sponsorship, now or in the future.

• An Associate's degree in Health Information Technology is preferred.

• Two years of experience with Diagnosis Related Groups (DRG), ICD-9-CM/ICD-10-CM/PCS, CPT, and HCPCS coding.

• One or more of the following certifications may be necessary: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Professional Coder (CPC).

• Current knowledge of Coding Clinics, coding newsletters, and other professional resources is essential.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentive options may be available as part of the total compensation package.

• Equal opportunity employer dedicated to diversity.