Coder Quality Specialist - Remote, United States

Centauri Health Solutions, Inc.; Phoenix (AZ); Remote; USD 90,000 - 130,000; Full time

Job summary

Centauri Health Solutions, Inc. is seeking a Coding Quality Specialist to conduct coding quality reviews for Medicaid, Medicare, and Commercial lines, ensuring ICD-10-CM codes align with clinical documentation and guidelines.

The role requires 5+ years of certified coding credentials (AHIMA/AAPC) and 2+ years of risk adjustment audits, with strong communication, organizational skills, and the ability to work remotely in a fast-paced environment.

Qualifications

• Minimum of 5 years certified with a core coding credential (AHIMA/AAPAHIMA CCS/CCS-P or AAPC CPC/CRC).
• Minimum of 3 years of recent production coding experience in Retrospective Risk Adjustment (last 6 months).
• Minimum of 2 years auditing coder work in Risk Adjustment.
• Medicaid coding knowledge (primary) with Medicare/Commercial exposure; Complete Code Capture within at least 1 year.
• No apprentice credentials accepted; strong organizational and communication skills; proficient in basic IT tools; remote work capability.

Responsibilities

• Perform coding quality reviews of medical records to ensure ICD-10-CM codes are accurate and supported by clinical documentation.
• Provide formal audit reports and educate coders based on findings.
• Maintain current knowledge of ICD-10-CM, CMS requirements, and state/federal regulations.
• Achieve audit accuracy targets (e.g., 95%+).
• Meet productivity requirements per project terms.
• Adhere to client guidelines when overriding other guidelines.
• Suggest process improvements to improve coding outcomes.

Skills

Organizational skills

Technical proficiency

Microsoft Outlook

Microsoft Word

Microsoft Excel

Written communication

Verbal communication

Remote work capability

Education

AHIMA/AAPAHIMA 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