Lead Senior Coder QA

About Us:

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs.

The Lead Senior Coder shall be certified as RHIA, RHIT, CCS, CPC with a minimum of five (5) years' experience in abstracting and ICD-9/ICD-10-CM coding of general acute hospital inpatient, outpatient, and physician medical records and serve as the gold standard for all medical record coding projects. This role performs intake, medical record abstraction, and coding validation in accordance with RADV contractual, and organizational guidelines, while applying expertise in CMS Part C risk adjustment data validation methods. The Lead Senior Coder shall be knowledgeable about managed care and health plans, capable of functioning in a QA lead role for their team, responsible for training medical record reviewers, and is accountable for the work performed by their team to ensure it meets contractual expectations.

• Perform first and second level coding validation review of inpatient, outpatient, and physician office medical records per Risk Adjustment Data Validation (RADV) and Improper Payment Measure (IPM) guidelines.
• Perform intake evaluations including validity status of medical records and attestations, non-compliance issues, and other validations checks as required per RADV and IPM guidelines.
• Perform Medical Record Appeal reviews per RADV guidelines.
• Assist Project Manager with development of training materials.
• Assist with training of new coders.
• Mediate coding decisions between the Senior and Mid-level Coders and give feedback to Coders as appropriate.
• Respond independently to medical records requiring escalation due to illegible entries that may impact the HCC, clinical questions, conflicting documentation, and other coding or legibility grey areas.
• Accountable for the work performed by your team during intake, abstraction, and appeals.
• Ensure your team receives timely input and feedback regarding the timeliness and quality of medical record reviews.
• Conduct QA reviews of team members each week.
• Work with coders to identify the root causes of performance deficits and provide opportunities to develop new skills or refresh existing ones to address skill gaps.
• Accurately enter data into encoder, CDAT/HPMS, and other as required software using a personal computer, keyboard and/or mouse.
• Follow all established processes and procedures.
• Maintain security and confidentiality of medical records and Protected Health Information (PHI).
• Consistently meet or exceed productivity and accuracy standards of 95% minimum IRR established by the customer and/or the company.

EEO Employer:

RELI Group is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

HUBZone:

We encourage all candidates who live in a HUBZone to apply. You can check to see if your address is located in a HUBZone by accessing the SBA HUBZone Map.

The annual salary range for this position is $50,000 to $80,000. Actual compensation will depend on a range of factors, including but not limited to the individual's skills, experience, qualifications, certifications, location, other business and organizational needs, and applicable employment laws. The estimate displayed represents the typical salary range for this position and is just one component of the total compensation package for employees. RELI Group provides a variety of additional benefits to its employees. For additional details on the benefits that RELI Group offers click here