Senior Medical Coder

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

📋 Description

• Conduct diagnosis coding for inpatient, outpatient, and physician office medical records in accordance with Risk Adjustment/Medicare Part C standards.

• Execute intake validity assessments on each submitted medical record to ensure documentation is from an appropriate physician specialty, includes relevant service dates for the specific Part C audit, contains an acceptable physician/practitioner signature, and review submitted Attestation.

• Log all process-related information in the system following contract and organizational protocols.

• Carry out Medical Record Dispute and Appeal evaluations, including technical writing in line with Part C guidelines.

• Offer Appeals support as a RADV Subject Matter Expert upon request from CMS.

• Engage in QA Panel discussions regarding medical record review intake/coding and appeals as needed.

• Collaborate with physician reviewers as required.

• Address inquiries from coders through the escalation process.

• Accurately input data into encoders, systems, and other required software using a personal computer, keyboard, and/or mouse.

• Adhere to all established processes and protocols.

• Report unique record or process issues to the Project Lead, Project Manager, or Project Director.

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

• Consistently achieve or surpass the productivity and accuracy standards of a minimum of 95% IRR set by the customer and/or the company.

• Regularly meet attendance standards established by the company.

• Interact appropriately with peers, co-workers, other Contractors, and the customer when necessary.

• Contribute to fostering a positive team environment.

• Assist the Project Manager in developing training materials.

• Support the training and feedback process for coders.

• Perform other assigned duties and projects.

⛳️ Requirements

• A minimum of five (5) years of experience in coding for general acute hospitals (inpatient and outpatient).

• Must be a certified coder credentialed by a recognized credentialing body (AAPC, AHIMA).

• Acceptable certifications include CPC, CCS, RHIA, RHIT; CRC certification is a plus.

• Preferred experience in leading and/or supervising personnel in abstracting and ICD-9/ICD-10 coding.

• Experience in Risk Adjustment Data Validation or CMS-HCC audits is preferred.

• Background in conducting medical record coding audits including complex medical record abstraction is desired.

• Ability to work independently while maintaining a high level of concentration.

• Demonstrated consistency, speed, and accuracy in task execution.

• Proficient in reading, analyzing, and interpreting physician documentation.

• Strong written and verbal communication skills with the ability to engage professionally at all organizational levels.

• Capable of collaborating effectively in a team environment and interfacing with both internal and external team members.

• Proficient in Microsoft Office Suite.

• Flexibility and capability to plan, prioritize, and execute multiple tasks in a fast-paced setting.

• Strong commitment to maintaining confidentiality and integrity.

🏝️ Benefits

• Health insurance

• Flexible work arrangements