Coder Quality Specialist

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.

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

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

Why You’ll Love Centauri (Our Promise to You)

We believe that caring for our members starts with caring for our team, and we are committed to providing a rewarding environment where employees can grow, excel, and achieve both personal and professional goals.

Comprehensive medical, dental, vision, and prescription coverage

Wellness program supporting overall well-being

Company-paid basic life and AD&D insurance

401(k) plan with company match

Tuition reimbursement opportunities

Paid time off for vacation and illness

Six paid company holidays

Floating holiday

Company-paid training and computer equipment

Performance-based bonus program

Paid time off for volunteer activities

Employee referral bonus program

Career development and training opportunities, including leadership growth

Centauri Health Solutions is an equal opportunity employer and is committed to providing reasonable accommodations to qualified individuals with disabilities in accordance with applicable law.