Centauri Health Solutions, Inc
Coding Quality Specialist
Centauri Health Solutions, Inc, Salt Lake City, Utah, United States
Join to apply for the
Coding Quality Specialist - Remote
role at
Centauri Health Solutions, Inc .
Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange. In partnership with our clients, we improve the lives and health outcomes of the members and patients we touch through compassionate outreach, sophisticated analytics, clinical data exchange capabilities, and data‑driven solutions. Our solutions address complex problems such as uncompensated care within health systems, appropriate risk‑adjusted revenue for specialized sub‑populations, and improving access to and quality of care measurement. Headquartered in Scottsdale, Ariz., Centauri Health Solutions employs 1,700 dedicated associates across the country and has been recognized on the Inc. 5000 since 2019 and the Deloitte Technology Fast 500™ 2020 list.
Role Summary The Coding Quality Specialist conducts coding quality reviews on internal and external coders to ensure diagnoses are accurately assigned based on clinical documentation, ICD‑10‑CM Official Guidelines, AHA Coding Clinic Guidance, CMS program guidance, and all regulatory, internal, and procedural standards. The role primarily focuses on Medicaid Complete Code Capture with potential extensions to Medicare Advantage Risk Adjustment or Commercial Risk Adjustment.
Role Responsibilities
Perform coding quality reviews of medical records to ensure ICD‑10‑CM codes are accurately assigned and supported by clinical documentation.
Provide formal reports on audit findings and conduct education for internal and external coders based on those findings.
Maintain current knowledge of ICD‑10‑CM codes, CMS documentation requirements, and state and federal regulations.
Pass a coding quiz with at least 80% accuracy.
Consistently maintain a minimum 95% accuracy on audits as evaluated by coding leadership.
Meet minimum productivity requirements as outlined by the project terms.
Adhere to client guidelines when superseding other guidelines.
Assist coding leadership by making recommendations for process improvements to enhance coding goals and outcomes.
Handle other related duties as required or assigned.
Role Requirements
Minimum of 3 recent years of production coding experience in Retrospective Risk Adjustment coding (must be within the last 6 months).
Minimum of 2 years’ experience conducting coder audits in the Risk Adjustment environment.
Required code‑set knowledge and coding experience in Medicaid (primary), Medicare, and Commercial; minimum 1 year coding experience with Complete Code Capture.
Minimum of 5 years certified with a core coding credential from AHIMA or AAPAHIMA – CCS, CCS‑P, AAPC – CPC, CRC (no apprentice credentials accepted).
Strong organizational skills.
Technical savvy with high competence in basic computers, Microsoft Outlook, Word, and Excel.
Strong written and verbal communication skills.
Ability to work independently in a remote environment.
Benefits
Competitive compensation with bonus eligibility according to the company’s plan.
Generous paid time off.
Matching 401(k) program.
Tuition reimbursement and annual salary reviews.
Comprehensive health plan.
Opportunities for volunteer activities on company time and professional development.
We are an equal‑opportunity employer and will provide reasonable accommodation to those unable to be vaccinated where it is not an undue hardship to the company. Centauri requires that several in‑person and hybrid office workers be fully vaccinated; new employees may need proof of vaccination by their start date.
Seniority Level:
Mid‑Senior
Employment Type:
Full‑time
Job Function:
Quality Assurance – Hospitals and Health Care
#J-18808-Ljbffr
Coding Quality Specialist - Remote
role at
Centauri Health Solutions, Inc .
Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange. In partnership with our clients, we improve the lives and health outcomes of the members and patients we touch through compassionate outreach, sophisticated analytics, clinical data exchange capabilities, and data‑driven solutions. Our solutions address complex problems such as uncompensated care within health systems, appropriate risk‑adjusted revenue for specialized sub‑populations, and improving access to and quality of care measurement. Headquartered in Scottsdale, Ariz., Centauri Health Solutions employs 1,700 dedicated associates across the country and has been recognized on the Inc. 5000 since 2019 and the Deloitte Technology Fast 500™ 2020 list.
Role Summary The Coding Quality Specialist conducts coding quality reviews on internal and external coders to ensure diagnoses are accurately assigned based on clinical documentation, ICD‑10‑CM Official Guidelines, AHA Coding Clinic Guidance, CMS program guidance, and all regulatory, internal, and procedural standards. The role primarily focuses on Medicaid Complete Code Capture with potential extensions to Medicare Advantage Risk Adjustment or Commercial Risk Adjustment.
Role Responsibilities
Perform coding quality reviews of medical records to ensure ICD‑10‑CM codes are accurately assigned and supported by clinical documentation.
Provide formal reports on audit findings and conduct education for internal and external coders based on those findings.
Maintain current knowledge of ICD‑10‑CM codes, CMS documentation requirements, and state and federal regulations.
Pass a coding quiz with at least 80% accuracy.
Consistently maintain a minimum 95% accuracy on audits as evaluated by coding leadership.
Meet minimum productivity requirements as outlined by the project terms.
Adhere to client guidelines when superseding other guidelines.
Assist coding leadership by making recommendations for process improvements to enhance coding goals and outcomes.
Handle other related duties as required or assigned.
Role Requirements
Minimum of 3 recent years of production coding experience in Retrospective Risk Adjustment coding (must be within the last 6 months).
Minimum of 2 years’ experience conducting coder audits in the Risk Adjustment environment.
Required code‑set knowledge and coding experience in Medicaid (primary), Medicare, and Commercial; minimum 1 year coding experience with Complete Code Capture.
Minimum of 5 years certified with a core coding credential from AHIMA or AAPAHIMA – CCS, CCS‑P, AAPC – CPC, CRC (no apprentice credentials accepted).
Strong organizational skills.
Technical savvy with high competence in basic computers, Microsoft Outlook, Word, and Excel.
Strong written and verbal communication skills.
Ability to work independently in a remote environment.
Benefits
Competitive compensation with bonus eligibility according to the company’s plan.
Generous paid time off.
Matching 401(k) program.
Tuition reimbursement and annual salary reviews.
Comprehensive health plan.
Opportunities for volunteer activities on company time and professional development.
We are an equal‑opportunity employer and will provide reasonable accommodation to those unable to be vaccinated where it is not an undue hardship to the company. Centauri requires that several in‑person and hybrid office workers be fully vaccinated; new employees may need proof of vaccination by their start date.
Seniority Level:
Mid‑Senior
Employment Type:
Full‑time
Job Function:
Quality Assurance – Hospitals and Health Care
#J-18808-Ljbffr