Data Integrity Specialist, ICD-10

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

📋 Description

• Review and confirm the accuracy, completeness, and compliance of risk adjustment coding for internal claim submissions.

• Carry out pre-claim, concurrent, prospective, and retrospective audits.

• Ensure adherence to CMS Risk Adjustment Methodology rules and coding/documentation guidelines.

• Track daily production volume and uphold an accuracy threshold of 95%–98%.

• Process standardized risk adjustment encounters based on cases-per-hour expectations.

• Conduct pre-claim audits and rectify improper codes prior to claim submission.

• Validate diagnoses against clinical documentation and MEAT criteria.

• Ensure that chronic conditions are actively managed during in-person visits.

• Identify and address unsupported, suspect, or inaccurately coded conditions.

• Discover trends, missed opportunities, and areas for improvement through retrospective audits.

• Monitor performance using accuracy trends, audit outcomes, and turnaround times.

• Collaborate with Clinical Documentation Improvement teams to enhance provider education and documentation strategies.

• Maintain compliance with internal policies and external regulatory requirements.

• Support readiness for internal, external, and health plan audits, including RADV and plan audits.

• Analyze audit trends and inform the CDI Manager about risk areas and potential improvement strategies.

• Engage in risk adjustment strategy projects, prospective programs, and suspect initiatives.

⛳️ Requirements

• At least 4 years of experience in ICD-10 Auditing.

• Current coding certification: CRC, CPC, or CPC-H required; CPC-As are not accepted.

• High school diploma is required.

• Bachelor’s Degree in Healthcare, Finance, or Business is preferred.

• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.

• Proficient understanding of ICD-9-CM, ICD-10-CM, CPT, and HCPCS coding.

• Familiarity with regulatory requirements and compliance standards.

• Proficient in Microsoft Office Suite.

• Understanding of coding and compliance standards.

• Strong skills in writing, grammar, spelling, punctuation, and sentence structure.

• Competence in keyboarding and software skills for generating correspondence, charts, spreadsheets, and other relevant information.

• Analytical problem-solving orientation.

• Ability to manage multiple priorities effectively.

• Demonstrated integrity, discretion, and maturity.

🏝️ Benefits

• Annual bonus.

• Comprehensive healthcare coverage.

• 401K plan with matching contributions.

• Health, wellness, and financial benefits.