Coder Quality Specialist - Remote, United States

Centauri Health Solutions; United States; Remote; USD 110,000 - 140,000; Full time

Job summary

Centauri Health Solutions, Inc. seeks a Coding Quality Specialist to review diagnoses coding accuracy against clinical documentation and official guidelines. This remote role focuses on Medicaid line of business with potential Medicare Advantage and Commercial risk adjustment duties.

You will generate formal audit reports, educate internal and external coders, and maintain current knowledge of regulatory requirements. Strong communication is essential.

Qualifications

• Certified coding professional with AHIMA or AAPC credentials.
• Minimum 5 years of certified coding experience in risk adjustment.
• Experience auditing coders in Medicaid/Medicare environments.
• Expert knowledge of ICD-10-CM and CMS guidelines.

Responsibilities

• Perform coding quality reviews to ensure ICD-10-CM codes match clinical docs.
• Provide formal audit reports and coder education based on findings.
• Stay current on ICD-10-CM codes and CMS/state/federal requirements.
• Maintain high accuracy in audits and meet productivity targets.
• Adhere to client guidelines when prioritizing coding guidance.
• Suggest process improvements to enhance coding outcomes.
• Handle related duties as required.

Skills

Organizational skills

Communication skills

Microsoft Office

Education

AHIMA/AAPC certification

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