Senior CDI & Coding Specialist - Remote

Nascentia Health; City of Syracuse (NY); Remote; USD 90,000 - 109,000; Full time

Benefits offered by this job

Retention bonuses

401k with employer match

Medical/Dental/Vision plans

Tuition reimbursement

Work-life balance — no weekends

HSA funding

Employee Recognition Platform

Paid Time Off

Job summary

Nascentia Health seeks a Senior CDI & Coding Specialist to ensure clinical documentation accuracy, support HEDIS quality measurement, and uphold CMS-HCC risk adjustment across health plan operations. You will serve as an internal subject matter expert, collaborating with Quality Improvement, Utilization Management, Clinical Ops and Provider Relations.

The role is remote-first, with standard business hours Monday–Friday, and requires active coding certifications and 3–5 years of experience in

Qualifications

• Active CPC, CCS, CRC or equivalent national certification.
• 3–5 years of medical coding, clinical documentation improvement, risk adjustment, or clinical data validation.
• Strong knowledge of ICD-10-CM coding guidelines and documentation requirements.
• Experience with Medicare Advantage, Managed Care, or Health Plan operations.
• Working knowledge of HEDIS quality measurement and CMS-HCC risk adjustment methodologies.
• Experience reviewing medical records for coding accuracy and documentation completeness.
• Ability to work independently and collaborate across multiple departments.

Responsibilities

• Review medical records to evaluate documentation completeness, clinical specificity, and coding accuracy.
• Validate ICD-10-CM, CPT, CPT II, and HCPCS coding against supporting clinical documentation.
• Identify missing or unsupported documentation and recommend clarification or correction.
• Conduct prospective and retrospective coding reviews.
• Support coding audits, documentation improvement initiatives, and regulatory compliance.
• Serve as an internal coding resource for clinical, quality, and operational teams.
• Support HEDIS medical record review, abstraction, and validation activities.
• Identify documentation supporting HEDIS measure compliance and gap closure.
• Review records for services completed but not represented in data.
• Evaluate coding opportunities for CPT II, procedures, and diagnosis codes for quality reporting.
• Support data validation, audits, and data reconciliation.
• Review records to validate risk-adjustable diagnoses and documentation.
• Identify gaps and opportunities for provider clarification.
• Assist with CMS-HCC coding accuracy and risk adjustment data integrity.
• Collaborate with provider-facing teams to strengthen documentation of chronic and complex conditions.

Skills

Analytical skills

Communication skills

Problem-solving

Cross-department collaboration

Education

CPC/CCS/CRC certification

Job description

Nascentia Health seeks a Senior CDI & Coding Specialist to ensure clinical documentation accuracy, support HEDIS quality measurement, and uphold CMS-HCC risk adjustment across health plan operations. You will serve as an internal subject matter expert, collaborating with Quality Improvement, Utilization Management, Clinical Ops and Provider Relations.

The role is remote-first, with standard business hours Monday–Friday, and requires active coding certifications and 3–5 years of experience in