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Sr. Medical Coder

Perform intake and coding validation on medical records and enter the corresponding data into Clinical Data Abstraction Tool (CDAT) in accordance with contractual and organizational guidelines. Assist Project Director with any additional responsibilities requested.

Essential Functions

  • Perform primary and secondary coding validation review of inpatient, outpatient, and physician office medical records per Risk Adjustment Data Validation (RADV) guidelines.
  • Perform intake evaluation include validity status of medical records and attestations, non-compliance issues, and other validations checks as required per RADV guidelines.
  • Perform Medical Record Dispute reviews per RADV guidelines.
  • Provide testimony at Medicare Advantage Organization appeal hearings.
  • Mediate coding decisions between the Senior and Primary Coders and give feedback to Primary Coders as appropriate.
  • Answer questions from Primary and Senior coders through the escalation process.
  • Accurately enter data into encoder, CDAT, and other as required software using a personal computer, keyboard and/or mouse.
  • Follow all established processes and procedures.
  • Report problems to Project Director with regard to unique record or process issues.
  • Maintain security and confidentiality of medical records and Protected Health Information (PHI).
  • Consistently meet or exceed productivity and accuracy standards established by the customer and/or the Company
  • Consistently meet attendance standards established by the Company.
  • Interact appropriately with peers, co-workers, other Contractors, and the customer, when necessary. Contribute to building a positive team spirit.
  • Assist Project Director with development of training materials.
  • Assist with training of new coders.
  • Perform other duties and projects as assigned
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