Certified Medical Coding Specialist

Pay: $23.97 to $28.97/hour
Assignment Length: 6 Months with possibility to extend or convert
Schedule: Full-Time ONSITE ONCE A WEEK

Overview:

The Quality Assurance Coder/Auditor will support risk adjustment initiatives through medical record review, coding audits, provider education, and quality assurance activities. This individual will ensure accurate diagnosis coding, HCC capture, and compliance with CMS and Medicare Advantage requirements while helping improve documentation practices and coding accuracy.

Responsibilities:

• Review medical records and supporting documentation to determine coding accuracy, completeness, and compliance with CMS guidelines.
• Perform HCC coding reviews and abstract diagnosis codes to the highest level of specificity.
• Conduct quality assurance audits of supplemental data submissions and vendor coding activities.
• Identify coding trends, documentation gaps, and risk mitigation opportunities.
• Analyze medical records for valid encounters, provider signatures, and face-to-face visit requirements.
• Develop and deliver provider education regarding coding best practices, documentation requirements, and healthcare gap closure strategies.
• Track audit findings and prepare monthly reports with recommendations for management.
• Maintain current knowledge of Medicare Managed Care Manual Chapter 7, ICD-10 coding guidelines, and risk adjustment methodologies.
• Collaborate with internal stakeholders to improve coding accuracy and risk adjustment outcomes.

Qualifications:

Required:

• 5+ years of professional coding experience.
• 3+ years of HCC coding experience.
• Strong understanding of Risk Adjustment and Medicare Advantage programs.
• Knowledge of ICD-10 coding guidelines and HCC methodologies.
• Understanding of anatomy, pathophysiology, and medical terminology.
• Experience reviewing medical records and performing coding audits.
• Proficiency with Microsoft Office Suite.
• High School Diploma or GED.

Required Certifications (At least one of the Following):

• Certified Risk Adjustment Coder (CRC)
• Certified Professional Coder (CPC)
• Certified Outpatient Coder (COC)
• Certified Coding Specialist – Physician Based (CCS-P)

Preferred:

• Medicare Advantage health plan experience.
• HEDIS and/or CMS Stars experience.
• RADV audit experience.
• Clinical background (RN, LPN, MA, CNA).
• RHIT or RHIA credentials.
• CPMA or CDEO certification.

What We Look For:

• HCC coding and Risk Adjustment expertise.
• Medicare Advantage experience.
• HEDIS, Stars, or Quality Improvement experience.
• Strong medical record review and auditing background.
• CPC, CRC, COC, CCS-P, or CPMA certification.
• Experience working with major health plans such as Anthem, UnitedHealthcare, CVS/Aetna, Molina, Humana, Cigna, or WellCare.

• Highlight HCC coding experience with years of experience.
• Add Medicare Advantage and Risk Adjustment experience.
• Include HEDIS, NCQA, Stars, and RADV experience if applicable.
• Ensure coding certifications are prominently displayed.
• Quantify audit accuracy, productivity, and quality metrics when possible.
• Include provider education, training, or coding consultation experience.