Mid-Level Medical Coder

ePATHUSA, Inc.; Clive (IA); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Remote work

Training opportunities

Job summary

ePATHUSA, Inc. is seeking an experienced Medical Coder to support CMS RADV review efforts by validating medical record documentation, abstracting diagnoses, and ensuring ICD-10-CM coding accuracy in accordance with CMS requirements.

The ideal candidate will maintain a 95% accuracy rate, work remotely, and meet productivity targets while documenting determinations in the CDAT-M system and complying with HIPAA and CMS data-use terms.

Qualifications

• Active, valid coding certification from AHIMA or AAPC (CPC/COC/CIC/CRC/CCA/CCS).
• Minimum of 2 years professional coding experience with ICD-10-CM.
• Experience coding across hospital inpatient, hospital outpatient, and physician office settings.
• Ability to pass a federal background check and obtain CMS security clearance.
• Remote work readiness for a fully remote CMS RADV contract in the US.

Responsibilities

• Perform intake review of medical records to ensure CMS RADV readiness.
• Abstract diagnoses in ICD-10-CM per CMS-approved RADV workflows.
• Evaluate documentation against CMS-HCC model requirements.
• Utilize CMS-approved coding tools (e.g., 3M Encoder) for accuracy.
• Document determinations in CDAT-M per SOP; escalate complex issues.
• Meet productivity targets and maintain 95% accuracy.
• Attend CMS/RADV training sessions and stay current with guidance.
• Handle PHI in compliance with HIPAA and data-use agreements.

Skills

Attention to detail

Produce accurate coding under metrics

Remote work adaptability

Education

AHIMA or AAPC certification (CPC/COC/CIC/CRC/CCA/CCS)

Tools

CDAT-M platform

CMS-approved tools

Job description

ePathUSA is looking for an experienced Medical Coder to support CMS RADV review efforts by validating medical record documentation, abstracting diagnoses, and ensuring coding accuracy in accordance with ICD-10-CM, CMS-HCC, and regulatory requirements. The ideal candidate will demonstrate strong attention to detail, a commitment to quality, and the ability to meet established performance standards.Job Duties:Perform medical record intake review, verifying that documentation submitted by Medicare Advantage Organizations meets required format, provider type, signature, and date-of-service criteria before records advance to coding review.Perform diagnosis code abstraction on hospital inpatient, hospital outpatient, and physician medical records in accordance with ICD-10-CM coding guidelines and CMS-approved RADV workflows.Evaluate medical record documentation against CMS-HCC (Hierarchical Condition Category) model requirements to determine whether submitted diagnoses are substantiated.Utilize CMS-approved computer-assisted coding tools (such as the 3M Encoder Tool) to support accurate and efficient review.Accurately document all intake and abstraction determinations within the CDAT-M system per CMS-approved standard operating procedures.Identify complex, ambiguous, or discrepant medical record issues and escalate them to Senior Coders for resolution rather than making unilateral determinations outside scope.Meet established productivity standards (approximately 8 intake reviews per hour or 2.5 abstraction reviews per hour, sustained across a 7-hour productive workday).Maintain a minimum 95% individual accuracy rate, subject to ongoing quality assurance sampling and inter-rater reliability review.Attend required CMS and RADV Independent Coding Consultant (ICC) training sessions (minimum 4 per contract period of performance) and stay current on evolving coding guidance.Contribute practical, front-line insight to workflow and reporting improvement recommendations for the CDAT-M platform based on day-to-day review experience.Handle protected health information (PHI) and other sensitive data in strict compliance with HIPAA, CMS data confidentiality requirements, and contract-specific Data Use Agreement terms.Required Qualifications• Must complete a coding assessment• Active, valid coding certification from AHIMA or AAPC, one of the following: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Risk Adjustment Coder (CRC), Certified Coding Associate (CCA), or Certified Coding Specialist (CCS).• Minimum of 2 years of professional coding experience, with ICD-10-CM proficiency required (ICD-9-CM familiarity a plus for legacy record review).• Experience coding across multiple sites of service (hospital inpatient, hospital outpatient, and/or physician office settings).• Strong attention to detail and ability to work accurately against defined productivity metrics in a production coding environment.• Ability to pass a federal background investigation and obtain the position-appropriate personnel security clearance/credential required for CMS system access (PIV or equivalent).• Comfortable working in a fully remote, virtual-meeting environment using standard CMS-approved collaboration and secure data-exchange tools.• Must be a U.S. citizen or otherwise authorized to work in the U.S. without sponsorship and reside within the United States (work outside the U.S. and its territories is prohibited under this contract absent prior written government approval).Preferred Qualifications• Prior experience with CMS Risk Adjustment programs, RADV, HCC coding, or Medicare Advantage payment methodology.• Experience with CDAT-M or similar federal medical record review platforms.• Bilingual Spanish/English coding capability (a limited number of positions supporting Spanish-language medical records, up to 1,000 records per period of performance across the program, may be prioritized for bilingual candidates).• Experience working under a government contract requiring CPARS-related performance standards, DUA compliance, or FISMA/HIPAA security controls.