Senior Medical Billing and Coding Coordinator (US Remote)

Essential Duties and Responsibilities:
- Audit medical records to ensure compliance with the Medicare Advantage Risk Adjustment standards including abstraction and assignment of appropriate codes based on clinical data.
- Enter coded data into a system accurately and validate date entered.
- Research correct coding practices, clearly document and share findings with others.
- Write clear and concise rationales that provide defensible support of decisions.
- Train staff members on the coding processes (both project specific and general coding).
- Perform QA audits on coding process.
- Recommend and suggest improvements to assigned projects.
- Perform other duties as assigned by management.

- Apply California Workers' Compensation regulations and calculate fee schedule allowances.

- Evaluate the accuracy and appropriateness of coded and billed medical information

- Develop final determination letters based on regulatory and clinical standards

- Abstract key data from complex case files and medical records

- Assign and verify CPT, HCPCS, and ICD-10-CM codes using industry-standard billing guidelines

- Apply specialized regulations including California Workers' Compensation, CMS policies, AMA CPT coding guidelines, and CA fee schedules

- Collaborate virtually with cross-functional teams to drive quality and compliance

Minimum Requirements

- High school diploma or equivalent with 4+ years of experience, or AA with 2+ years of experience.

- Preferred risk adjustment auditing experience of coding inpatient and outpatient medical records.
- CPC, CCS, or RHIT Certification required.
- Ability to use critical thinking skills.
- Must have excellent writing skills.

- Experience coding physician, inpatient and/or outpatient medical records required.

- Strong computer skills, including Word, Excel, and Outlook.

- Mathematical skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
- Active CPC, CCS, CIC, COC, CCS or RHIT certification required (AAPC or AHIMA accredited)

Preferred Requirements
- Bachelor's degree from an accredited institution
- Experience as a medical claim examiner, reviewing physician and hospital PPO contracts
- Experience with California Workers' Compensation Official Medical Fee Schedule
- Experience with CMS payment methodologies: IPPS, OPPS, DMEPOS and Physician Fee Schedule

Home Office Requirements
- Maximus provides company-issued computer equipment
- Private and secure workspace
- Reliable high-speed internet service


* Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity


* Minimum 5 Mpbs upload speeds

#LI-Remote

EEO Statement

Maximus is an equal opportunity employer.

We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.

Pay Transparency

Maximus compensation is based on various f...