Lead Senior Coder QA

Paycom - ATS; Milford Mill (MD); Remote; USD 65,000 - 75,000; Full time

Job summary

RELI Group is seeking a Lead Sr. Coder to manage and execute risk-adjustment coding reviews in a remote role serving stakeholders in Maryland. You will validate inpatient, outpatient, and physician records per RADV guidelines, while guiding up to 15 coders.

Maintain PHI security and drive quality and productivity targets. Ideal candidates have a certified medical coder credential, 5+ years of coding experience, and can train and mentor junior staff.

Qualifications

• Certified medical coder with US credentialing.
• 5+ years of abstracting and ICD-9/ICD-10-CM coding in hospital and physician records.
• Ability to lead and train medical record reviewers.
• Knowledge to serve as Master Coder for coding projects.

Responsibilities

• Perform primary and secondary coding validation review of inpatient, outpatient, and physician office medical records per RADV guidelines.
• Perform intake evaluation, validity status of medical records and attestations, non-compliance issues, and other validations per RADV guidelines.
• Perform Medical Record Dispute and Appeal reviews per RADV guidelines.
• QA coder reviews and provide feedback and training as needed to coders.
• Oversee team of up to 15 coders providing guidance and answering questions.
• Mediate coding decisions between Senior and Primary Coders and provide feedback.

Skills

Medical coding leadership

RADV guidelines

Quality assurance

Training coders

Education

High School

Tools

Encoder/CDAT-M

Job description

Job Details

Job Location: Remote - Windsor Mill, MD, Position Type: Full Time, Education Level: High School, Salary Range: $65000.00 - $75000.00

About Us

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact - whether we’re supporting data-driven decisions, modernizing systems or safeguarding critical programs.

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 include 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 as 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; and
• Ability to function in a lead role and/or train medical record reviewers; and
• Knowledge and skills to serve as “Master Coder” (i.e., gold standard) for all medical record coding projects

EEO Employer

RELI Groupis an Equal Employment Opportunity / Aff… All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

HUBZone

We encourage all candidates who live in a HUBZone to apply. You can check to see if your address is located in a HUBZone by accessing theSBA HUBZone Map.

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. The estimate displayed represents the typical salary range for this position and is just one component of the total compensation package for employees.

RELI Group provides a variety of additional benefits to its employees. For additional details on the benefits that RELI Group offers click here.