Program Integrity Coding & Research Medical Coder CPC, CRC,CCS

The Program Integrity Coding & Research Medical Coder acts as a Medical Coding subject matter expert for complex coding concerns and serve as primary coding resource for Program Integrity.

The Program Integrity Coding & Research Medical Coder Functions as a Subject Matter Expert for Risk Adjustment and Professional Coding at CSI and is allocated to projects that require a coding professional with significant technical acumen in coding conventions for both CAI and CDPS. 

This teammate is key to assisting a technology vendor validate software tools that are business enablers, and when improperly functioning, can have a detrimental impact to the public persona and profitability of the vendor.  The Medical Coder is in a position of high visibility for CSI, and has access to proprietary tools in a position requiring high trust and confidentiality.

The What you Want to Know:

• 100% Remote
• Contract, Full-Time Hours ( 30 hour minimum commitment)
• Active, verifiable CPC, CRC, CCS REQUIRED
• Minimum 3 years Diagnosis coding experience required
• 1 Year Medicaid coding experience required
• Experience in working on multiple NLP/AI/Coding Platforms with Logic
• Hourly Pay
• CRC Coders MUST have experience in diagnosis coding beyond HCC Coding or have done CAI Projects with “Complete Coding” methodology

The What you Will be Doing:
The Medical Coder will be responsible for validating code assignments made by AI solutions with various algorithmic and natural language processing coding logic, and therefore is able to both apply codes to discern those that are missed by a coding algorithm or engine rule, and is also able to determine if codes are over-applied without sufficient clinical and contextual evidence to support their selection.

The Medical Coder will also work in a team environment in collaboration with a technology vendor that will lead iterative review sessions to solicit feedback from the Coding Team, in addition to working independently, relying heavily on their own experience, knowledge based resource and critical thinking.

Position Requirements:

• Bachelor’s degree in Business Administration or related field or equivalent years of relevant work experience is required
• Minimum of five (3) years of experience in medical coding, to include experience in program integrity coding audit, is required
• CRC Coders MUST have experience in diagnosis coding beyond HCC Coding or have done CAI Projects with “Complete Coding” methodology
• Experience with reimbursement methodology (APC, DRG, OPPS) is required
• Proficient in Microsoft Office toolset
• Proven ability to establish effective working relationships with stakeholders at all different levels
• Excellent written and verbal communication skills
• Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of stakeholders
• Ability to work independently and within a team environment
• Ability to multi-task and prioritize work to meet project deadlines
• Effective listening and critical thinking skills
• Flexibility during organizational and/or business changes
• Strong interpersonal and relationship building skills
• Effective problem-solving skills with attention to detail
• Ability to effectively and efficiently lead and/or work within a project team
• Decision making/problem solving skills
• Ability to develop, prioritize and accomplish goals
• Ability to coordinate and lead cross-functional teams

This is a remote, work from home position. You may be located anywhere within the US.