Apply Now

Medical coder

Remote • Posted 1 day ago • Updated 1 day ago

Contract W2

24 Months

No Travel Required

Remote

$20 - $28/yr

Fitment

Dice Job Match Score™

To see how well you match this job, please log in or create an account.

Once logged in, be sure to complete your profile to get the most accurate match score.

🔢 Crunching numbers...

Job Details

Skills

medical coding

Summary

Senior Coder

Remote

Key Responsibilities

Perform diagnosis code abstraction on original medical record reviews, applying ICD-10-CM coding guidelines (and ICD-9-CM for records with dates of service through September 30, 2015) in accordance with CMS-approved RADV workflows.
Serve as the primary escalation point for Mid-Level Coders, resolving complex, ambiguous, or discrepant intake and coding issues forwarded during initial review.
Perform appeals-related diagnosis abstraction, incorporating additional documentation and context supplied by the Medicare Advantage Organization to determine whether audited HCCs are substantiated.
Adhere strictly to the SOW's separation-of-review requirement during appeals: coders may not review the same medical record during appeals that they reviewed during the original abstraction.
Provide professional-quality editorial review of appeal coders' written submissions, ensuring clarity, structural consistency, and defensibility of updated coding summaries before they are sent to the RADV Appeals Support Contractor.
Validate that documentation genuinely supports the diagnosis codes assigned, applying sound clinical and coding judgment consistent with CMS-HCC hierarchy logic.
Consult with the Physician Consultant on complex clinical documentation questions arising during abstraction or appeals review.
Support quality assurance sampling and inter-rater reliability (IRR) reviews as directed by the Lead Senior Coder, QA.
Maintain a minimum 95% individual accuracy rate across all review types (intake, abstraction, and appeals).
Contribute workflow and reporting improvement recommendations to CDAT-M based on patterns observed in escalated and appealed cases.
Attend required CMS and RADV Independent Coding Consultant (ICC) training sessions and maintain current knowledge of evolving RADV audit methodology and coding guidance.
Handle protected health information (PHI) and other sensitive data in strict compliance with HIPAA, CMS data confidentiality requirements, and contract-specific Data Use Agreement terms.

Requirements

Active, valid coding certification from AHIMA or AAPC, one of the following: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Risk Adjustment Coder (CRC), Certified Coding Associate (CCA), or Certified Coding Specialist (CCS).
Minimum of 5 years of professional coding experience, with demonstrated proficiency in both ICD-9-CM and ICD-10-CM coding guidelines.
Demonstrated experience resolving complex or disputed coding determinations, ideally including formal escalation, quality review, or appeals-related coding work.
Experience coding across multiple sites of service (hospital inpatient, hospital outpatient, and physician office settings).
Strong written communication skills, with demonstrated ability to produce clear, well-organized coding rationale suitable for submission in a formal appeals or audit context.
Ability to pass a federal background investigation and obtain the position-appropriate personnel security clearance/credential required for CMS system access (PIV or equivalent).
Comfortable working in a fully remote, virtual-meeting environment using standard CMS-approved collaboration and secure data-exchange tools.

Preferred Qualifications

Prior experience with CMS Risk Adjustment programs, RADV, HCC coding, or Medicare Advantage payment methodology.
Prior experience specifically in a coding appeals, dispute resolution, or medical record review escalation role.
Experience with CDAT-M or similar federal medical record review platforms.
Bilingual Spanish/English coding capability.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10383289
Position Id: 9089268
Posted 1 day ago

Create job alert

Never miss an opportunity! Create an alert based on the job you applied for.

Similar Jobs

Healthcare Risk Adjustment Coder

Remote

•

2d ago

Healthcare Risk Adjustment CoderElite Technical is seeking an experienced Risk Adjustment Coder with a strong background in Medicare Advantage Risk Adjustment coding and ACA Risk Adjustment coding. ResponsibilitiesReview and assess medical record documentation and accurately assign ICD-10-CM diagnosis codes for Medicare Advantage and ACA Risk Adjustment programs.Perform retrospective and prospective coding reviews to identify supported HCC conditions.Evaluate medical records for coding accuracy,

Easy Apply

Contract

Depends on Experience

Medical Coder

Remote

•

12d ago

Role: Medical Coder Location: Remote Job description: Function Asks: We are seeking dedicated and detail-oriented specialists who possess a coding certificate and have a strong understanding of records review. They will be responsible for handling appeals for Medicare members, specifically working on NCD/LCD denials, Duplicate denials, and MUE denials. The role involves reviewing medical records, comparing findings to CMS guidelines, and determining if conditions of coverage exist. If condition

Easy Apply

Full-time

Depends on Experience

Medical Record Audit Specialist - BehavioralHealth

Remote

•

4d ago

Certified Medical Coder/Medical Record Audit Specialist - Behavioral HealthLocation: Fully Remote, with occasional travel to Downtown Indianapolis, IN (expenses covered)Job Summary:We are seeking a Certified Medical Coder/Medical Record Audit Specialist with strong Behavioral Health coding experience to support a state Medicaid program engagement. This role focuses on auditing medical records and claims documentation for coding accuracy and compliance, identifying billing and documentation issue

Easy Apply

Contract

Depends on Experience

Coding Compliance Auditor

Remote

•

2d ago

Immediate need for a talented Coding Compliance Auditor. This is a 06+ Months Contract opportunity with long-term potential and is located in US (Remote). Please review the job description below and contact me ASAP if you are interested. Job ID:26-28929 Pay Range: $35 - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: This position is responsible for the

Easy Apply

Contract

$35 - $40

Search all similar jobs

Remote jobs at Avenue Code, LLC