Senior Professional Coder (Remote)

We are seeking a highly skilled Senior Professional Coder with expertise in Risk Adjustment Coding (HCC), to join our team. The ideal candidate will have strong coding experience, leadership skills, and a solid background in health insurance audits and utilization review. This is a fully remote position that offers the opportunity to work with a dynamic team in a fast-paced environment.

Candidate must locate in NJ/NY/PA/CT/DE

Key Responsibilities:

• Perform code abstraction using ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and all applicable state and federal regulations.
• Work with Risk Adjustment programs such as Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, IVA (Initial Validation Audit), and RADV (Risk Adjustment Data Validation).
• Maintain a minimum of 95% accuracy on coding quality audits.
• Compile chart review findings, analyze data, and implement action plans to improve provider performance.
• Develop and implement quality assurance processes to ensure data integrity for diagnoses submitted to regulatory agencies.
• Educate and train new staff to maintain high-quality coding and chart reviews.
• Collaborate with cross-departmental teams to support coding initiatives and process improvements.
• Act as a Subject Matter Expert to identify opportunities to enhance risk adjustment programs.
• Support coding initiatives related to CMS/Auditing, Quality Assurance, and Process Improvement.
• Conduct mock audits and surveillance activities targeting problematic diagnoses.

Qualifications:

• Certification: RHIT (Registered Health Information Technologist) or CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) required.
• Experience:
• 5+ years of Medical Coding experience, with a focus on Risk Adjustment Coding (HCC).
• 3-4 years of experience in Risk Adjustment Coding and chart audits.
• Minimum of 5+ years of experience in Health Insurance Audits, Utilization Review, or Quality Chart Audits.
• Education: Bachelor's degree required.
• Skills:
• Proficiency in ICD-9/ICD-10, CPT, HCPC coding.
• Strong leadership and presentation skills.
• Ability to analyze data and implement improvement plans.
• Knowledge of medical terminology and the healthcare delivery system.
• Effective verbal and written communication skills.

Additional Skills & Abilities:

• Must have effective communication and team collaboration skills.
• Proficient in Microsoft Office (Word, Excel) and relevant coding software.
• Ability to demonstrate professionalism and adhere to ethical business practices.
• Proven problem-solving skills and the ability to exercise sound judgment.
• Ability to manage multiple priorities and deadlines.

Why Join Us?

• Work in a dynamic and supportive remote work environment.
• Competitive compensation and benefits package.
• Opportunities for professional growth and development.

How to Apply:

If you are a passionate and experienced coder with a strong background in Risk Adjustment and are interested in this opportunity, please apply with your updated resume.

Benefits:

We offer a competitive compensation package that includes:

* Pay Rate: $30 per $40/Hour

o Note: Pay rate will be commensurate with experience.

* Medical for full time employees

* Dental, and Vision Insurance

* Life Insurance, Short-Term Disability, Long-Term Disability, etc.