Medical Review Coder Specialist (Medicare)

Empower AI is a government-focused AI company serving federal agencies across Health, Defense, and Civilian missions. The company is headquartered in Reston, Virginia and emphasizes workforce transformation and support for active-duty and veteran employees.

The Medical Review Coder Specialist reviews sampled Medicare claims and associated medical records to make payment determinations based on coding and practice guidelines. This role applies coding guidance from AHA Coding Clinic and AMA CPT Assistant and supports CERT Program policies and contract responsibilities.

Responsibilities

• Analyze medical records to validate ICD-10-CM, ICD-10-PCS, CPT-4, HCPCS II coding, and MS-DRG assignment for acute inpatient hospital claims and outpatient claims
• Review codes, diseases, conditions, and procedures on acute inpatient hospital records
• Review clinical documentation to ensure assigned codes are appropriately supported
• Conduct claims analysis using ICD-10-CM, CPT-4, and HCPCS Level II coding principles
• Use electronic health information imaging and enter coding review decisions into the electronic database module from the grouper for inpatient DRG claims
• Use internet and intranet sources for policy verification
• Use Microsoft Office and other software templates as source input for claims review
• Meet quality and production standards
• Ensure compliance with the department's quality management system and ISO requirements