Sr Certified Coding Specialist- Remote

Job Introduction

Maximus is looking to hire a Senior Certified Coding Specialist to support our Office of Inspector General (OIG) program! This is a fully remote position. 

 

Why Maximus?

• Fully Remote Position
• Paid Time Off and Holidays
• Work/Life Balance
• Tuition Reimbursement

Work schedule will align to the Central Time Zone. 

 

Project-Specific Essential Job Duties:

• Audit inpatient, outpatient, and physician medical records to ensure compliance with the Medical Advantage Risk Adjustment standards including abstraction and assignment of appropriate ICD-9-CM and ICD-10-CM codes based on medical record documentation and clinical findings
• Expertise in the assignment of ICD-9-CM and ICD-10-CM codes and the correct application of the Official Guidelines for Coding and Reporting for each type of service (inpatient and outpatient)
• Apply knowledge of inpatient and outpatient ICD diagnosis code guidelines and clinical documentation requirements to assign HCCs
• Determine if code assignments submitted by Medicare Advantage Plans that result in Hierarchical condition categories (HCCs) are accurate thereby affecting the risk adjustment payment calculations made to Medicare Advantage Plans/Organizations
• Thorough knowledge of Risk Adjustment Diagnosis Validation (RADV) coding rules and requirements
• Ability to author clear and concise rationales that provide defensible support of decisions
• Collaborate with physicians and other coders to address issues were guidance and documentation are not clear
• Accurately enter abstracted data and codes into a system and validate data entered
• Research correct coding practices, clearly document and share findings with others
• Recommend and suggest improvements to assigned projects
• Communicate with physicians and other team members either through discussion or in writing (e.g., formal queries) regarding missing, unclear, or conflicting health record documentation and policies to obtain clarification to provide accurate decisions
• Conduct follow-up re-evaluation of coding decisions to determine accuracy and make necessary revisions and adjustments to clarify decision rationales
• Act as a consultant to client and make recommendations based on experience performing audits
• Attend meetings with client when necessary to provide coding expertise when requested by Project Manager
• Attend kick-off meetings with client audit teams to understand audit background and ask questions to provide clarification
• Assume responsibility for professional development by participating in workshops, conferences and/ or in-services to maintain client required credentials
• Keep current with changes in coding guidelines, compliance, reimbursement, and other relevant regulatory updates
• Contribute to a positive working environment and perform other duties as assigned or directed to enhance the overall efforts of the organization
• Maintain positive and open communication with team members and physician reviewers
• Adhere to internal controls and reporting structure
• Comply with all relevant policies, procedures, guidelines and other regulatory, compliance and accreditation standards
• Demonstrate excellent observation skills, analytical thinking and problem solving plus good verbal and written communication
• Performs related duties as required

 

 

 

Education and Experience Requirements

Project-Specific Education and Experience Requirements:

• Associate’s Degree in Health Information Technology preferred
• Minimum of 5 years of experience performing risk adjustment audits, and/or inpatient and outpatient coding
• AHIMA or AAPC professional coders credentialing required
  • (RHIT, CCS, CCS-P, CPC, CRC) who are duly experienced in the coding and auditing of hospital inpatient, outpatient and physician/practitioner medical records and claims.
• Expertise in the assignment of ICD-9-CM and ICD-10-CM codes and the application of the Official Guidelines for Coding and Reporting for each type of service (inpatient and outpatient)
• CCDS or CDIP Certification required
• Position contingent on passing a level 5 public trust background clearance and approval of credentials and experience by the client

Home Office Requirements:

• Maximus provides company-issued computer equipment
• Reliable high-speed internet service
  • Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
  • Minimum 5 Mpbs upload speeds
• Private and secure workspace

MAXIMUS Introduction

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