Coder Quality Specialist - Remote, United States

Centauri Health Solutions, Inc; Phoenix (AZ); Remote; USD 85,000 - 110,000; Full time

Job summary

Centauri Health Solutions, Inc. seeks a Coding Quality Specialist to conduct quality reviews and ensure accurate ICD-10-CM coding based on clinical documentation and guidelines. You will provide audit findings, educate coders, and maintain up-to-date knowledge of regulatory requirements.

The role supports Medicaid, Medicare Advantage Risk Adjustment, or Commercial lines and is suited to a remote work environment with strong organizational and communication skills.

Qualifications

• 5+ years certified coding with AHIMA or AAPAHIMA credential.
• 3 recent years of production coding in Retrospective Risk Adjustment (last 6 months).
• 2 years auditing coders in Risk Adjustment environments.
• Medicaid primary knowledge with Medicare and Commercial coding.
• 1 year coding experience with Complete Code Capture.
• Pass coding quiz with 80% accuracy.
• Maintain 95% accuracy on audits as per leadership.

Responsibilities

• Perform coding quality reviews of medical records to ensure ICD-10-CM codes are accurate and justified by documentation.
• Provide formal audit reports and educate coders based on findings.
• Stay current with ICD-10-CM, CMS requirements, and state/federal regulations.
• Achieve minimum productivity per project terms and adhere to client guidelines.
• Recommend process improvements to enhance coding goals and outcomes.
• Handle related duties as required.

Skills

Strong written and verbal comms

Strong organizational skills

Independent remote work capability

Education

AHIMA/AAPAHIMA core coding credential

CCS/CCS-P/CPC/CRC certification

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Your Daily Mission

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.

Who You Are

• Minimum of 5 years certified with a core coding credential from AHIMA or AAPAHIMA – CCS, CCS-P, AAPC – 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
• Minimum of 5 years certified with a core coding credential from AHIMA or AAPAHIMA – CCS, CCS-P, AAPC – CPC, CRC (no apprentice credentials accepted)
• 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

The Reality of the Role

• 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