Medical Records Coder-Senior

We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. 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.

We are seeking an experienced and detail-oriented Senior Medical Coder to support our Medicare Part C Risk Adjustment Data Validation (RADV) initiatives. The ideal candidate will have strong experience in ICD‑9‑CM/ICD‑10‑CM coding across various care settings, including inpatient, outpatient, and physician office encounters. The candidate will perform diagnosis coding, support intake reviews, conduct appeal responses, and contribute to quality assurance efforts.

Perform diagnosis coding of inpatient, outpatient, and physician office medical records per Risk Adjustment/Medicare Part C guidelines.

Perform intake validity checks on each medical record submitted to ensure the submitted medical record documentation is from an acceptable physician specialty type, relevant dates of service for the specific Part C audit, include an acceptable physician/practitioner signature, and review submitted Attestation, is submitted. Record all process information in system in accordance with contract and organizational guidelines and processes.

Perform Medical Record Dispute and Appeal reviews including technical writing per Part C guidelines.

Provide Appeals support as RADV Subject Matter Expert at CMS request.

Participate and contribute to QA Panel discussions for medical record review intake/coding and appeals, as needed.

Interact with the physician reviewer(s) as required.

Accurately enter data into encoder, system, and other as required software using a personal computer, keyboard and/or mouse.

Report problems to Project Lead, Project Manager, or 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 of 95% minimum IRR established by the customer and/or the company.

Interact appropriately with peers, co‑workers, other Contractors, and the customer, when necessary. Contribute to building a positive team spirit.

Assist Project Manager with development of training materials.

Assist with training and feedback of coders.

Perform other duties and projects assigned.

A minimum of five (5) years of experience in coding general acute hospital (inpatient and outpatient) and/or multi-specialty physician office medical records by applying ICD‑9‑CM/ICD‑10‑CM coding guidelines.

Must be a certified coder who is credentialed by a recognized credentialing institution (AAPC, AHIMA). CPC, CCS, RHIA, RHIT.

Experience in leading and/or supervising personnel in abstracting and ICD‑9/ICD‑10 coding preferred.

Experience in Risk Adjustment Data Validation or CMS‑HCC audits preferred.

Experience in performing medical record coding audits including complex medical record abstraction.

Must be proficient in Microsoft Office Suite.

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.

We encourage all candidates who live in a HUBZone to apply.