ICD-10 Certified Data Integrity Specialist

Job Summary

To support organizational performance under value-based care contracts, the full-time ICD-10 Certified Data Integrity Specialist will review and ensure the accuracy, completeness, and compliance of risk adjustment coding for internal claim submissions while working remotely.

Key responsibilities

• Ensure compliance with CMS Risk Adjustment Methodology rules and regulations related to coding and documentation guidelines
• Perform pre-claim audits to correct improper codes and validate that reported diagnoses meet clinical documentation criteria
• Complete retrospective audits to identify trends and areas for improvement in coding and documentation, collaborating closely with CDI teams

Required qualifications

• A minimum of 4 years experience in ICD-10 Auditing
• Current coding certification such as CRC, CPC, or CPC-H is required
• High school diploma required; Bachelor's Degree in Healthcare, Finance, or Business preferred
• Advanced knowledge of ICD-9-CM, ICD-10-CM, CPT, HCPCS coding, and medical terminology
• Proficient in Microsoft Office Suite and coding compliance standards