• Coding. Code a variety of records within established productivity guidelines with at least 95% accuracy on a consistent basis; group and assign DRGs and appropriate E/M levels with at least 95% accuracy on a consistent basis • Abstraction. Abstract ER provider assignment into an abstracting system with at least 99% accuracy on a consistent basis; abstract other required information accurately including discharge dispositions, SPARCS data, physician names and procedure dates • Quality Assurance. Accurately assign the facility charge for emergency room and observation records; identify errors and process accounts for corrections; correct errors identified through various auditing processes; manage problematic workflow edits and other technical issues to ensure timely resolution

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Coding Compliance Specialist is responsible for overseeing and evaluating assigned Risk Adjustment Data Validation (RADV) medical record review (MRR) work performed under the contract. This role ensures compliance with CMS RADV guidelines, coding standards, and risk adjustment policies while maintaining the highest quality and accuracy in medical record documentation. This is a part-time, remote position with flexible scheduling, ideal for experienced professionals seeking autonomy and work-life balance. Key Responsibilities - Ensure adherence to CMS RADV payment and risk adjustment policies. - Provide expert guidance on coding and documentation standards, including ICD-CM, HCC, and Risk Adjustment. - Review escalated Medicare RADV medical record cases and resolve complex issues. - Maintain quality assurance and compliance across all RADV review activities. - Collaborate with stakeholders to improve processes and ensure contractual obligations are met. - Conduct medical record, coding, and policy research. - Develop and deliver training programs related to RADV and coding compliance. - Perform medical record reviews involving PHI/PII, identify conflicting documentation, and provide coding clarifications. Qualifications - Prior experience working directly on the CMS RADV contract is required. - Minimum 5 years of supervisory experience in medical record review, preferably RADV. - Proven expertise in reviewing escalated Medicare RADV medical record cases. - In-depth knowledge of RADV Medical Record Review (MRR) processes, ICD-CM coding standards, CMS RADV payment and risk adjustment policies, and documentation guidelines. Education & Certification - Medical Coding Certification from an accredited entity (e.g., AAPC, AHIMA). - RHIT, RHIA, CCS, CPC, CRC. - Advanced knowledge of coding systems and compliance regulations. Skills & Competencies - Strong analytical and problem-solving skills. - Excellent communication and leadership abilities. - Detail-oriented with a commitment to accuracy and compliance. - Ability to manage multiple priorities and meet deadlines.

• Review inpatient medical records to assign appropriate ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes • Ensure coding accuracy and compliance with AHIMA, AHA, CMS, and official coding guidelines • Abstract clinical data accurately into the coding system • Meet established productivity and quality benchmarks • Identify documentation issues and work with CDI or providers as appropriate • Maintain confidentiality and comply with HIPAA regulations • Participate in audits, education, and quality improvement initiatives as required • Stay current with coding updates, regulatory changes, and payer requirements

• Responsible for abstracting and assigning valid CPT, ICD-9/10, and HCPCS codes • Identify compliance concerns, trends, and educational opportunities • Work independently with limited oversight • Accurately abstract information from service documentation • Assign appropriate CPT, ICD-9/10, and HCPCS codes • Communicate professionally with providers and management • Responsible for coding encounters in a timely manner • Meet or exceed coding production and quality standards • Understand and apply regulatory changes • Review and resolve denials