Coder Quality Specialist - Remote, United States

Your Daily Mission

The Coding Quality Specialist conducts coding quality reviews on internal and external coders to ensure diagnoses are appropriately and accurately assigned based upon clinical documentation, ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinic Guidance, CMS program guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Coding Quality Specialist will apply guidance provided for the medical record code abstraction primarily for Medicaid lines of business (Complete Code Capture), but may also include Medicare Advantage Risk Adjustment or Commercial Risk Adjustment.

Who You Are

Minimum of 5 years certified with a core coding credential from AHIMA or AAPAHIMA – CCS, CCS-P, AAPC – CPC, CRC.


Minimum of 3 recent years of production coding experience in Retrospective Risk Adjustment coding (must be within last 6 months)
Minimum of 2 years experience conducting coder audits in the Risk Adjustment environment
Required code set knowledge and coding experience in Medicaid (primary), Medicare, Commercial Minimum of 1 year coding experience with Complete Code Capture
Minimum of 5 years certified with a core coding credential from AHIMA or AAPAHIMA – CCS, CCS-P, AAPC – CPC, CRC (no apprentice credentials accepted)
Strong organizational skills
Technical savvy with high level of competence in basic computers, Microsoft Outlook, Word, and Excel
Strong written and verbal communication skills
Ability to work independently in a remote environment




The Reality of the Role

Perform coding quality reviews of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation
Provide formal reports on audit findings and conduct education to internal and external coders based upon those findings
Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations
Ability to pass coding quiz with 80% accuracy
Consistently maintain a minimum 95% accuracy on audits by coding leadership
Meet minimum productivity requirements as outlined by the project terms
Ability to adhere to client guidelines when superseding other guidelines
Assist coding leadership by making recommendations for process improvements to further enhance coding goals and outcomes
Handle other related duties as required or assigned