Senior Professional Coder (Remote)
Posted 2 weeks ago by 1750865207
Negotiable
Outside
Remote
USA
Summary: We are looking for a Senior Professional Coder specializing in Risk Adjustment Coding (HCC) to join our remote team. The ideal candidate will possess strong coding experience, leadership skills, and a background in health insurance audits and utilization review. This role requires candidates to be located in NJ, NY, PA, CT, or DE. The position offers a dynamic work environment with opportunities for professional growth.
Key Responsibilities:
- Perform code abstraction using ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and all applicable state and federal regulations.
- Work with Risk Adjustment programs such as Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, IVA (Initial Validation Audit), and RADV (Risk Adjustment Data Validation).
- Maintain a minimum of 95% accuracy on coding quality audits.
- Compile chart review findings, analyze data, and implement action plans to improve provider performance.
- Develop and implement quality assurance processes to ensure data integrity for diagnoses submitted to regulatory agencies.
- Educate and train new staff to maintain high-quality coding and chart reviews.
- Collaborate with cross-departmental teams to support coding initiatives and process improvements.
- Act as a Subject Matter Expert to identify opportunities to enhance risk adjustment programs.
- Support coding initiatives related to CMS/Auditing, Quality Assurance, and Process Improvement.
- Conduct mock audits and surveillance activities targeting problematic diagnoses.
Key Skills:
- Certification: RHIT (Registered Health Information Technologist) or CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) required.
- 5+ years of Medical Coding experience, with a focus on Risk Adjustment Coding (HCC).
- 3-4 years of experience in Risk Adjustment Coding and chart audits.
- Minimum of 5+ years of experience in Health Insurance Audits, Utilization Review, or Quality Chart Audits.
- Bachelor's degree required.
- Proficiency in ICD-9/ICD-10, CPT, HCPC coding.
- Strong leadership and presentation skills.
- Ability to analyze data and implement improvement plans.
- Knowledge of medical terminology and the healthcare delivery system.
- Effective verbal and written communication skills.
Salary (Rate): undetermined
City: undetermined
Country: USA
Working Arrangements: remote
IR35 Status: outside IR35
Seniority Level: undetermined
Industry: Other
We are seeking a highly skilled Senior Professional Coder with expertise in Risk Adjustment Coding (HCC), to join our team. The ideal candidate will have strong coding experience, leadership skills, and a solid background in health insurance audits and utilization review. This is a fully remote position that offers the opportunity to work with a dynamic team in a fast-paced environment.
Candidate must locate in NJ/NY/PA/CT/DE
Key Responsibilities:
- Perform code abstraction using ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and all applicable state and federal regulations.
- Work with Risk Adjustment programs such as Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, IVA (Initial Validation Audit), and RADV (Risk Adjustment Data Validation).
- Maintain a minimum of 95% accuracy on coding quality audits.
- Compile chart review findings, analyze data, and implement action plans to improve provider performance.
- Develop and implement quality assurance processes to ensure data integrity for diagnoses submitted to regulatory agencies.
- Educate and train new staff to maintain high-quality coding and chart reviews.
- Collaborate with cross-departmental teams to support coding initiatives and process improvements.
- Act as a Subject Matter Expert to identify opportunities to enhance risk adjustment programs.
- Support coding initiatives related to CMS/Auditing, Quality Assurance, and Process Improvement.
- Conduct mock audits and surveillance activities targeting problematic diagnoses.
Qualifications:
- Certification: RHIT (Registered Health Information Technologist) or CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) required.
- Experience:
- 5+ years of Medical Coding experience, with a focus on Risk Adjustment Coding (HCC).
- 3-4 years of experience in Risk Adjustment Coding and chart audits.
- Minimum of 5+ years of experience in Health Insurance Audits, Utilization Review, or Quality Chart Audits.
- Education: Bachelor's degree required.
- Skills:
- Proficiency in ICD-9/ICD-10, CPT, HCPC coding.
- Strong leadership and presentation skills.
- Ability to analyze data and implement improvement plans.
- Knowledge of medical terminology and the healthcare delivery system.
- Effective verbal and written communication skills.
Additional Skills & Abilities:
- Must have effective communication and team collaboration skills.
- Proficient in Microsoft Office (Word, Excel) and relevant coding software.
- Ability to demonstrate professionalism and adhere to ethical business practices.
- Proven problem-solving skills and the ability to exercise sound judgment.
- Ability to manage multiple priorities and deadlines.
Why Join Us?
- Work in a dynamic and supportive remote work environment.
- Competitive compensation and benefits package.
- Opportunities for professional growth and development.
How to Apply:
If you are a passionate and experienced coder with a strong background in Risk Adjustment and are interested in this opportunity, please apply with your updated resume.
Benefits:
We offer a competitive compensation package that includes:
* Pay Rate: $30 per $40/Hour
o Note: Pay rate will be commensurate with experience.
* Medical for full time employees
* Dental, and Vision Insurance
* Life Insurance, Short-Term Disability, Long-Term Disability, etc.