Certified Clinical Quality Coder

Job Summary

To support clinical integration efforts, the full-time Certified Clinical Quality Coder will conduct reviews of outpatient medical records using ICD-10-CM and CPT coding, ensuring accurate assignment of diagnoses and procedures while working remotely.

Key responsibilities:

• Conduct medical record reviews to ensure accurate coding and reporting of diagnoses and procedures
• Perform pre-appointment reviews of encounters to identify potential clinical conditions for physician alert
• Support risk adjustment code validation for CMS and HHS Risk Adjustment models

Required qualifications:

• High School Diploma or General Education Diploma (GED)
• Certification as a CRC, CPC, or other relevant coding certification
• One year of recent experience with CMS-HCC and HHS-HCC risk adjustment coding
• Advanced knowledge of ICD-10 coding conventions and Medicare Advantage coding requirements
• Proficient in using coding software and reference materials for diagnosis code assignment