Coding Quality Specialist

CODING QUALITY SPECIALIST 

About Centauri Health Solutions:
Centauri Health Solutions is a healthcare technology and services company powered by analytics. Our tailored solutions enable health plans and hospitals to manage variable revenue, through a custom-built workflow platform, which seamlessly integrates cross-functional service and support. We offer Risk Adjustment, a variety of Eligibility and Enrollment Services to meet the needs of specialized populations, Out-of-State Billing and Quality program efforts. 
Role Overview:
The Coder Quality Specialist conducts Coding Quality audits on internal and external coders to ensure diagnoses are appropriately and accurately assigned based upon written clinical documentation, Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures.  The Coder Quality Specialist applies guidance provided for the audit of the following programs; including but not limited to, Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, Commercial IVA (Initial Validation Audit), and Medicare RADV (Risk Adjustment Data Validation).
Role Responsibilities:
Perform audits of coded medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation
Provide formal report(s) on audit findings and conduct education to internal and external coders based upon those findings
Assist coding leadership by making recommendations for process improvements to further enhance Coding Quality goals and outcomes
Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations
Consistently maintain a minimum 95% accuracy rate on audits by coding leadership
Meet minimum productivity requirements as outlined by the project terms
Performs other related duties as required or assigned
Understands and agrees to role-specific information security access and responsibilities
Ensures safety and confidentiality of data and systems by adhering to the organizations information security policies
Reads, understands and agrees to security policies and complete all annual security and compliance training
Role Requirements:
Minimum of 3 years of hands on coding experience in the Risk Adjustment environment.
Minimum of 2 years' experience conducting coder audits in the Risk Adjustment environment.
Strong Excel skills (advanced level)
Technically savvy with Microsoft Office applications
Strong written and verbal communication skills
Ability to work independently in a remote environment
High School Diploma
Completion of an accredited medical coding program is highly desired, but not required
Current core coding credential through AHIMA or AAPC (RHIT, CCS, CCS-P, CPC, CIC, etc.) and the AAPC CRC (Certified Risk Adjustment Coder) coding certification are both required.
We believe strongly in providing employees a rewarding work environment in which to grow, excel and achieve personal as well as professional goals. We offer our employees competitive compensation and a comprehensive benefits package that includes generous paid time off, a matching 401(k) program, tuition reimbursement, annual salary reviews, a comprehensive health plan, the opportunity to participate in volunteer activities on company time, and development opportunities.

Centauri Health Solutions is an equal opportunity employer.