Centauri Health Solutions delivers data-driven technology solutions that transform fragmented clinical and member data into actionable intelligence — maximizing accuracy, quality performance, and outcomes for health plans and health systems. They improve patient and member outcomes by providing advocacy, advanced data insights, and intelligent clinical data delivery, addressing critical healthcare challenges and improving access and quality of care.
As a Medical Coding Quality Specialist, you will conduct coding quality reviews on internal and external coders to ensure diagnoses are appropriately and accurately assigned based on clinical documentation, ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinic Guidance, CMS program guidance, and in accordance with all state and federal regulations, internal policies, and procedures. You will primarily work with Medicaid lines of business (Complete Code Capture), but may also include Medicare Advantage Risk Adjustment or Commercial Risk Adjustment.
Responsibilities include performing coding quality reviews of medical records, providing formal audit reports and coder education, maintaining current knowledge of ICD-10-CM codes and CMS documentation requirements, meeting productivity and accuracy standards, adhering to client guidelines, and recommending process improvements.
- Minimum of 3 recent years of production coding experience in Retrospective Risk Adjustment coding (within last 6 months)
- At least 2 years experience conducting coder audits in Risk Adjustment environment
- Coding knowledge and experience in Medicaid (primary), Medicare, Commercial
- Minimum 1 year coding experience with Complete Code Capture
- Minimum 5 years certified with a core coding credential from AHIMA or AAPC (CCS, CCS-P, CPC, CRC) – no apprentice credentials accepted
- Strong organizational and communication skills
- Proficient with computers, Microsoft Outlook, Word, Excel
- Ability to work independently in a remote environment
- Ability to pass coding quiz with 80% accuracy
- Ability to maintain minimum 95% accuracy on audits
- Ability to meet productivity requirements and follow client guidelines
- Comprehensive medical, dental, vision, and prescription coverage
- Wellness program
- Company-paid basic life and AD&D insurance
- 401(k) plan with company match
- Tuition reimbursement
- Paid time off (vacation, illness), six company holidays, and floating holiday
- Company-paid training and computer equipment
- Performance-based bonus program
- Paid time off for volunteer activities
- Employee referral bonus
- Career development and leadership training opportunities
Location
Texas, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
1 month ago