Coder Quality Specialist - Remote, United States

Centauri Health Solutions Inc; United States; Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) with company match

Tuition reimbursement

Paid time off

Job summary

Centauri Health Solutions is seeking a Coding Quality Specialist to conduct coding quality reviews and ensure ICD-10-CM codes are accurately assigned, supported by clinical documentation.

This role focuses on Medicaid line of business with potential Medicare Advantage Risk Adjustment or Commercial Risk Adjustment duties, requiring independence, strong auditing skills, and the ability to work remotely.

Qualifications

• 5+ years certified with AHIMA/AAPAHIMA credential (CCS/CCS-P/AAPC CPC/CRC)
• 3+ recent years of production coding experience in Retrospective Risk Adjustment coding (within last 6 months)
• 2+ years experience conducting coder audits in Risk Adjustment
• Medicaid/Medicare/Commercial coding knowledge (Complete Code Capture)

Responsibilities

• Perform coding quality reviews of medical records to ensure ICD-10-CM codes are accurate and supported by documentation
• Provide formal audit reports and conduct education for internal/external coders based on findings
• Maintain current knowledge of ICD-10-CM, CMS requirements, and state/federal regulations
• Pass coding quiz with 80% accuracy
• Maintain minimum 95% accuracy on audits by coding leadership
• Meet minimum productivity requirements as per project terms
• Adhere to client guidelines when superseding other guidelines
• Assist leadership with process-improvement recommendations
• Handle other related duties as required

Job description

Coding Quality Specialist

Centauri delivers data-driven technology solutions that transform fragmented clinical and member data into actionable intelligence — maximizing accuracy, quality performance, and outcomes for health plans and health systems. Through close collaboration with our customers, Centauri improves patient and member outcomes by providing advocacy, advanced data insights, and intelligent clinical data delivery. The company addresses critical healthcare challenges for complex populations and improves access and quality of care.

Headquartered in Tempe, Arizona, Centauri Health Solutions employs 1100 dedicated associates across the country and has been recognized on the Inc. 5000 list, the 2020 Deloitte Technology Fast 500™, and has been recognized as 2026 Best in KLAS for ADT Notifications.

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

Why You'll Love Centauri (Our Promise to You)

We believe that caring for our members starts with caring for our team, and we are committed to providing a rewarding environment where employees can grow, excel, and achieve both personal and professional goals.

• 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

Factors which may affect starting pay within this range may include geography/market, skills, education, experience, and other qualifications of the successful candidate.

Centauri Health Solutions is an equal opportunity employer and is committed to providing reasonable accommodations to qualified individuals with disabilities in accordance with applicable law.