Senior Certified Coding Specialist - Maximus Services, LLC

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 with client audit teams to understand audit background and ask questions to provide clarification.
• Assume responsibility for professional development by participating in workshops, conferences and/ or in-services to maintain client required credentials.
• Keep current with changes in coding guidelines, compliance, reimbursement, and other relevant regulatory updates.
• Contribute to a positive working environment and perform other duties as assigned or directed to enhance the overall efforts of the organization.
• Maintain positive and open communication with team members and physician reviewers.
• Adhere to internal controls and reporting structure.
• Comply with all relevant policies, procedures, guidelines and other regulatory, compliance and accreditation standards.
• Demonstrate excellent observation skills, analytical thinking and problem solving plus good verbal and written communication.
• Performs related duties as required

Project-Specific Education and Experience Requirements:
• Associate's Degree in Health Information Technology with minimum of 5 years of relevant experience performing risk adjustment audits. AHIMA and AAPC credentialed professional coders (RHIT, CCS, CCS-P, CPC, CPC-I, CRC) who are duly experienced in the coding and auditing of hospital inpatient, outpatient and physician/practitioner medical records and claims. These coders have expertise in the assignment of ICD-9-CM and ICD-10-CM codes and the application of the Official Guidelines for Coding and Reporting for each type of service (inpatient and outpatient). CCDS or CDIP Certification
• Required 5 years of risk adjustment auditing experience, and/or inpatient and outpatient coding.
• Position contingent on passing a level 5 public trust background clearance and approval of credentials and experience by the client.

Job Summary

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.

Minimum Requirements:
- High School diploma or equivalent with 2-4 years of experience.
- Associate degree preferred.

MAXIMUS Introduction

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.

EEO Statement

EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation.

Posted Max

USD $30.22/Hr.

Posted Min

USD $16.20/Hr.