[Hiring] Lead Senior Coder QA @RELI GROUP INC

Role Description

This role performs complex coding and dispute/appeal reviews, ensures compliance with RADV guidelines, provides quality assurance and feedback to coders, and serves as a subject matter expert and escalation point for coding questions. The Lead Sr. Coder also leads and supports a team of up to 15 coders, assists with training and development, and ensures established accuracy, productivity, confidentiality, and quality standards are consistently met.

• Perform primary and secondary coding validation review of inpatient, outpatient, and physician office medical records per Risk Adjustment Data Validation (RADV) guidelines.
• Perform intake evaluation including validity status of medical records and attestations, non-compliance issues, and other validations checks as required per RADV guidelines.
• Perform Medical Record Dispute and Appeal reviews per RADV guidelines.
• Perform QA of coder reviews and provide feedback and training as needed to coders.
• Oversee team of up to 15 primary and senior coders providing guidance and answering questions.
• Mediate coding decisions between the Senior and Primary Coders and give feedback to Coders as appropriate.
• Answer questions from Primary and Senior coders through the escalation process.
• Accurately enter data into encoder, CDAT-M, and other required software using a personal computer, keyboard and/or mouse.
• Follow all established processes and procedures.
• Report problems to Project Director with regard to unique record or process issues.
• Maintain security and confidentiality of medical records and Protected Health Information (PHI).
• Consistently meet or exceed productivity and accuracy standards of 95% minimum IRR established by the customer and/or the Company.
• Consistently meet attendance standards established by the Company.
• Interact appropriately with peers, co-workers, other Contractors, and the customer, when necessary. Contribute to building a positive team spirit.
• Assist Project Director with development of training materials.
• Assist with training of new coders.
• Perform other duties and projects as assigned by the Project Director.

Qualifications

• Must be a certified medical coder; with certification from any recognized United States medical coding credentialing institution.
• A minimum of five (5) years of experience in abstracting and ICD-9/ICD-10-CM coding of general acute hospital (inpatient and outpatient) and physician medical records by applying ICD-9/ICD-10-CM Coding Guidelines for inpatient and outpatient settings and related Official Coding Clinics.
• Ability to function in a lead role and/or train medical record reviewers.
• Knowledge and skills to serve as “Master Coder” (i.e., gold standard) for all medical record coding projects.

Benefits

• The annual salary range for this position is $65,000 to $75,000.
• Actual compensation will depend on a range of factors, including but not limited to the individual’s skills, experience, qualifications, certifications, location, other business and organizational needs, and applicable employment laws.
• RELI Group provides a variety of additional benefits to its employees.