Certified Coding Quality Specialist

Job Summary

Conducting coding quality reviews for Medicaid and Medicare lines of business, the part-time Certified Coding Quality Specialist will ensure accurate ICD-10-CM code assignments based on clinical documentation while working remotely.

Key responsibilities

• Perform coding quality reviews of medical records to verify accurate ICD-10-CM code assignments
• Provide formal reports on audit findings and conduct educational sessions for internal and external coders
• Maintain up-to-date knowledge of coding guidelines, CMS documentation requirements, and relevant regulations

Required qualifications

• Minimum of 5 years certified with a core coding credential from AHIMA or AAPC (e.g., CCS, CPC)
• At least 3 recent years of production coding experience in Retrospective Risk Adjustment coding
• A minimum of 2 years conducting coder audits in a Risk Adjustment environment
• Knowledge and experience with Medicaid coding (primary), Medicare, and Commercial coding
• Ability to pass a coding quiz with 80% accuracy and maintain a minimum 95% accuracy on audits