Lead Senior Coder QA

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

📋 Description

• Conduct primary and secondary coding validation reviews of inpatient, outpatient, and physician office medical records in accordance with RADV guidelines.

• Carry out intake evaluations, assessing the validity of medical records and attestations, addressing non-compliance issues, and performing other necessary validation checks as stipulated by RADV guidelines.

• Execute Medical Record Dispute and Appeal reviews following RADV guidelines.

• Ensure quality assurance of coder reviews while offering constructive feedback and training to coders.

• Supervise a team of up to 15 primary and senior coders, providing guidance and resolving queries.

• Facilitate mediation of coding decisions between Senior and Primary Coders and deliver feedback.

• Address inquiries from Primary and Senior Coders throughout the escalation process.

• Accurately input data into encoder, CDAT-M, and other necessary software using a personal computer, keyboard, and/or mouse.

• Adhere to established processes and procedures.

• Notify the Project Director of any unique record or process issues.

• Uphold the security and confidentiality of medical records and PHI.

• Engage appropriately with peers, co-workers, contractors, and clients.

• Foster a positive team spirit.

• Assist the Project Director in the creation of training materials.

• Aid in the training of new coders.

• Carry out additional duties and projects assigned by the Project Director.

⛳️ Requirements

• High School diploma or equivalent.

• Must hold certification as a medical coder.

• Certification from a recognized medical coding credentialing body in the United States.

• At least five (5) years of experience in abstracting and ICD-9/ICD-10-CM coding for general acute hospital (both inpatient and outpatient) and physician medical records.

• Ability to apply ICD-9/ICD-10-CM Coding Guidelines for both inpatient and outpatient settings, alongside related Official Coding Clinics.

• Capability to function in a lead capacity and/or train medical record reviewers.

• Possess the knowledge and skills to act as a “Master Coder” (i.e., gold standard) for all medical record coding initiatives.

• Consistently achieve or surpass a 95% minimum IRR accuracy standard.

• Regularly meet company attendance standards.

• Maintain the security and confidentiality of medical records and Protected Health Information (PHI).

🏝️ Benefits

• Additional benefits are included in the total compensation package.

• Equal Employment Opportunity / Affirmative Action employer.

• HUBZone candidates are encouraged to apply.