Perform medical record reviews for Medicare Advantage members to ensure diagnoses are accurately submitted to CMS for risk adjustment payments.
Responsibilities include validating outpatient and inpatient medical codes, coordinating on-site and remote chart reviews, reviewing claims data, supporting CMS appeals, analyzing audit results, and using NLP tools to identify codes for capture or deletion.
This role also serves as a subject matter expert on coding initiatives, supports physician education, and participates in internal and external audits and department projects.
- Certified Professional Coder (CPC, CPC-H) or Certified Coding Specialist (CCS), or equivalent education and experience
- 3 to 5 years of experience in medical claims review or claims processing
- 3 to 5 years of experience in quantitative or statistical analysis, preferably in healthcare
- Proficiency in ICD-9/10-CM medical coding
- Strong analytical skills and ability to interpret complex data sets
- Experience with Microsoft Excel and database query tools
- Excellent verbal and written communication skills
- Strong organizational, problem-solving, presentation, negotiation, and decision-making skills
- Ability to work with employees at all levels and manage multiple priorities
Preferred:
- RN license
- Bachelor's degree
- Knowledge of ICD-9-CM, ICD-10-CM, and CPT coding
- Professional designations such as CPC-H, CPC-P, or CRC
- Knowledge of HCC payment models and AHA Official Coding Guidelines
- Familiarity with hospital contract reimbursement
- Flexible work arrangements, including remote and hybrid opportunities
- Paid time off
- Tuition reimbursement
- Student loan repayment assistance
- Health, dental, and vision insurance
- Mental health and well-being programs
- Competitive pay
- Bonuses and investment plans
- Employee development and growth opportunities
- Additional paid time to volunteer
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$65,600 - $98,400
Remote work allowed
Yes
Posted
1 week ago