[Hiring] Coder Quality Specialist @Centauri Health Solutions

Role Description

The Coding Quality Specialist conducts coding quality reviews on internal and external coders to ensure diagnoses are appropriately and accurately assigned based upon clinical documentation, ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinic Guidance, CMS program guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Coding Quality Specialist will apply guidance provided for the medical record code abstraction primarily for Medicaid lines of business (Complete Code Capture), but may also include Medicare Advantage Risk Adjustment or Commercial Risk Adjustment.

Qualifications

• Minimum of 5 years certified with a core coding credential from AHIMA or AAPC (CCS, CCS-P, CPC, CRC).
• Minimum of 3 recent years of production coding experience in Retrospective Risk Adjustment coding (must be within last 6 months).
• Minimum of 2 years experience conducting coder audits in the Risk Adjustment environment.
• Required code set knowledge and coding experience in Medicaid (primary), Medicare, Commercial.
• Minimum of 1 year coding experience with Complete Code Capture.
• Strong organizational skills.
• Technical savvy with high level of competence in basic computers, Microsoft Outlook, Word, and Excel.
• Strong written and verbal communication skills.
• Ability to work independently in a remote environment.

Requirements

• Perform coding quality reviews of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
• Provide formal reports on audit findings and conduct education to internal and external coders based upon those findings.
• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.
• Ability to pass coding quiz with 80% accuracy.
• Consistently maintain a minimum 95% accuracy on audits by coding leadership.
• Meet minimum productivity requirements as outlined by the project terms.
• Ability to adhere to client guidelines when superseding other guidelines.
• Assist coding leadership by making recommendations for process improvements to further enhance coding goals and outcomes.
• Handle other related duties as required or assigned.

Benefits

• Comprehensive medical, dental, vision, and prescription coverage.
• Wellness program supporting overall well-being.
• Company-paid basic life and AD&D insurance.
• 401(k) plan with company match.
• Tuition reimbursement opportunities.
• Paid time off for vacation and illness.
• Six paid company holidays.
• Floating holiday.
• Company-paid training and computer equipment.
• Performance-based bonus program.
• Paid time off for volunteer activities.
• Employee referral bonus program.
• Career development and training opportunities, including leadership growth.