This is a remote position.

Key Responsibilities

• Perform medical record intake review, verifying that documentation submitted by Medicare Advantage Organizations meets required format, provider type, signature, and date-of-service criteria before records advance to coding review.
• Perform diagnosis code abstraction on hospital inpatient, hospital outpatient, and physician medical records in accordance with ICD-10-CM coding guidelines and CMS-approved RADV workflows.
• Evaluate medical record documentation against CMS-HCC (Hierarchical Condition Category) model requirements to determine whether submitted diagnoses are substantiated.
• Utilize CMS-approved computer-assisted coding tools (such as the 3M Encoder Tool) to support accurate and efficient review.
• Accurately document all intake and abstraction determinations within the CDAT-M system per CMS-approved standard operating procedures.
• Identify complex, ambiguous, or discrepant medical record issues and escalate them to Senior Coders for resolution rather than making unilateral determinations outside scope.
• Meet established productivity standards (approximately 8 intake reviews per hour or 2.5 abstraction reviews per hour, sustained across a 7-hour productive workday).
• Maintain a minimum 95% individual accuracy rate, subject to ongoing quality assurance sampling and inter-rater reliability review.
• Attend required CMS and RADV Independent Coding Consultant (ICC) training sessions (minimum 4 per contract period of performance) and stay current on evolving coding guidance.
• Contribute practical, front-line insight to workflow and reporting improvement recommendations for the CDAT-M platform based on day-to-day review experience.
• Handle protected health information (PHI) and other sensitive data in strict compliance with HIPAA, CMS data confidentiality requirements, and contract-specific Data Use Agreement terms.

Requirements

Required Qualifications

• Must complete assessment: Medical Coding Assessment
• Active, valid coding certification from AHIMA or AAPC, one of the following: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Risk Adjustment Coder (CRC), Certified Coding Associate (CCA), or Certified Coding Specialist (CCS).
• Minimum of 2 years of professional coding experience, with ICD-10-CM proficiency required (ICD-9-CM familiarity a plus for legacy record review).
• Experience coding across multiple sites of service (hospital inpatient, hospital outpatient, and/or physician office settings).
• Strong attention to detail and ability to work accurately against defined productivity metrics in a production coding environment.
• Ability to pass a federal background investigation and obtain the position-appropriate personnel security clearance/credential required for CMS system access (PIV or equivalent).
• Comfortable working in a fully remote, virtual-meeting environment using standard CMS-approved collaboration and secure data-exchange tools.
• Must be a U.S. citizen or otherwise authorized to work in the U.S. without sponsorship, and reside within the United States (work outside the U.S. and its territories is prohibited under this contract absent prior written government approval).

Preferred Qualifications

• Prior experience with CMS Risk Adjustment programs, RADV, HCC coding, or Medicare Advantage payment methodology.
• Experience with CDAT-M or similar federal medical record review platforms.
• Bilingual Spanish/English coding capability (a limited number of positions supporting Spanish-language medical records, up to 1,000 records per period of performance across the program, may be prioritized for bilingual candidates).
• Experience working under a government contract requiring CPARS-related performance standards, DUA compliance, or FISMA/HIPAA security controls.

Benefits

Benefit Package includes: Paid Sick Time Insurance for Medical, Dental, Vision and Life Available 401(k) including Employer Match HSA, Short-term & Long-term Disability Available We are an EEO/Veterans/Disabled employer