Job Description

Job Title: Med Coder/24/MCO400

Location

Telecommuter – Optum FL950

Schedule

This position is full-time (40 hours/week), Monday through Friday during normal business hours. Overtime may be required based on business needs.

We are seeking a Certified Medical Coder responsible for the accurate coding of professional medical services, including diagnoses, procedures, and modifiers, from medical records across multiple settings including Clinic, Outpatient, and Inpatient facilities.

The ideal candidate will have strong experience in CMS HCC Risk Adjustment Models, medical record review, and provider documentation validation. This role requires advanced coding expertise, attention to detail, and the ability to meet productivity and turnaround standards.

Key Responsibilities

• Accurately assign medical codes for diagnoses, procedures, evaluations, and ancillary services

• Review and interpret clinical documentation to identify applicable ICD-10-CM, CPT, HCPCS, and modifier codes

• Apply knowledge of anatomy, physiology, medical terminology, and disease processes to coding decisions

• Identify incomplete or unclear documentation and generate provider queries as needed

• Follow up with providers to obtain timely responses to coding queries

• Utilize coding software programs and coding reference materials effectively

• Apply post-query responses to finalize coding determinations

• Ensure compliance with Federal, State, Professional, and organizational coding guidelines

• Manage multiple coding assignments while maintaining productivity and turnaround standards

• Resolve coding edits and denials related to code assignments

• Participate in coding quality audits and respond to audit inquiries

• Educate and mentor team members to improve coding quality and accuracy

• Demonstrate understanding of coding impacts on the revenue cycle

• Perform additional duties as assigned

Required Qualifications

• High School Diploma or GED (or higher)

• 3+ years of coding experience, preferably in:

  • Medicare Advantage

  • Risk Adjustment/HCC Coding

• Active coding certification from AAPC or AHIMA, including but not limited to:

  • CPC

  • CPC-H

  • CPC-P

  • RHIT

  • RHIA

  • CCA

  • CCS

  • CCS-P

• Advanced knowledge of:

  • ICD-10-CM

  • CPT

  • HCPCS

  • Modifiers and coding guidelines

• Advanced understanding of:

  • Medical terminology

  • Anatomy and physiology

  • Disease processes

• Strong organizational skills with the ability to meet deadlines and productivity expectations

Preferred Qualifications

• Certified Risk Adjustment Coder (CRC)

• Experience with eClinical Works Practice Management System (eCW)

Interview Process

Video and/or phone interviews are required.

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