Sr Certified Coding Specialist- Remote

Description & Requirements

Maximus is looking to hire a Senior Certified Coding Specialist to support our Office of Inspector General (OIG) program.

This is a fully remote position.

Why Maximus?



* Fully Remote Position


* Paid Time Off and Holidays


* Work/Life Balance


* Tuition Reimbursement

Work schedule will align to the Central Time Zone.

Essential Duties and Responsibilities:

- Provides advanced clinical inquiry responses (verbal and written) to health related inquiries from consumers, educators or medical/health professionals.

- Provides medical subject matter expertise.

- Performs advanced database searches.

- Composes documents, reports, and correspondence.

- Documents all incoming inquiries.

- May assist in training and leading subordinate specialists.

- Provides routine reports on the functions supported by the team.

Project-Specific Essential Job Duties:



* Audit inpatient, outpatient, and physician medical records to ensure compliance with the Medical Advantage Risk Adjustment standards including abstraction and assignment of appropriate ICD-9-CM and ICD-10-CM codes based on medical record documentation and clinical findings


* Expertise in the assignment of ICD-9-CM and ICD-10-CM codes and the correct application of the Official Guidelines for Coding and Reporting for each type of service (inpatient and outpatient)


* Apply knowledge of inpatient and outpatient ICD diagnosis code guidelines and clinical documentation requirements to assign HCCs


* Determine if code assignments submitted by Medicare Advantage Plans that result in Hierarchical condition categories (HCCs) are accurate thereby affecting the risk adjustment payment calculations made to Medicare Advantage Plans/Organizations


* Thorough knowledge of Risk Adjustment Diagnosis Validation (RADV) coding rules and requirements


* Ability to author clear and concise rationales that provide defensible support of decisions


* Collaborate with physicians and other coders to address issues were guidance and documentation are not clear


* Accurately enter abstracted data and codes into a system and validate data entered


* Research correct coding practices, clearly document and share findings with others


* Recommend and suggest improvements to assigned projects


* Communicate with physicians and other team members either through discussion or in writing (e.g., formal queries) regarding missing, unclear, or conflicting health record documentation and policies to obtain clarification to provide accurate decisions


* Conduct follow-up re-evaluation of coding decisions to determine accuracy and make necessary revisions and adjustments to clarify decision rationales


* Act as a consultant to client and make recommendations based on experience performing audits


* Attend meetings with client when necessary to provide coding expertise when requested by Project Manager


* Attend kick-off meetings ...