Job Description

Medical Coder - Remote

Compensation: $18-$20 hourly DOE

Employment: 1099

Overview: Nexus HR is looking for experienced and certified Medical Coders to provide accurate, compliant, and high-quality coding services for one of our prestigious clients in the healthcare industry. This is a remote opportunity supporting risk adjustment coding for Medicare, Commercial, and Medicaid lines of business. Coders will work with clinical documentation and use client applications to extract ICD-10-CM codes while maintaining high standards of accuracy and compliance.

About the Job

The Medical Coder will be responsible for reviewing medical records and assigning appropriate ICD-10-CM codes for risk adjustment purposes. Coders will work on different projects throughout the coding season, including first-pass coding, submission review, and quality assurance. All coders are expected to maintain minimum quality and production benchmarks and will follow both client and industry coding guidelines.

Duties and Responsibilities:

• Assign appropriate ICD-10-CM codes to diagnoses and procedures in accordance with CMS/HHS and client-specific guidelines.

• Work across Medical, Commercial, and Medicaid Risk Adjustment projects.

• Use client-provided Application Services to code and maintain necessary documentation for rebuttal and quality control.

• Review all Dates of Service (DOS) to capture relevant risk-adjustable or all appropriate diagnoses based on the client’s selected Coding Approach (Best DOS or All DOS).

• Assign issue flags at the Medical Record, Diagnosis, and DOS levels for documentation issues.

• Participate in Submissions Review for higher-level approval of ICD-10-CM codes flagged for submission.

• Maintain a minimum of 98% monthly coding quality accuracy, with removal from the project if accuracy drops below 95% for two consecutive months.

• Submit daily production reports comparing volume coded to the daily target.

• Input required data simultaneously in client systems to ensure traceability and quality rebuttals.

• Follow HIPAA guidelines and protect all patient information.

• TLs, SMEs, and Managers must ensure adherence to TAT and take accountability for the team’s coding quality.

• Complete annual compliance training (HIPAA, Fraud, Waste & Abuse, Privacy & Security) and attest to reading client coding and ethics policies.

Qualifications :

• Minimum of 4 years of medical coding experience.
• Must demonstrate coding proficiency and knowledge.
• Licenses/Certifications (Required):
• AAPC (minimum CPC or CRC) OR\
• AHIMA (minimum CCS or CCA)
• Certifications must be current and not apprentice-level.
• Deep understanding of CMS ICD-10-CM Official Guidelines, AHA’s Coding Clinic, and risk adjustment principles.
• Ability to use NLP/Computer Assisted Coding tools (preferred).
• Excellent attention to detail, accuracy, and documentation.
• Ability to meet daily/weekly productivity and quality targets.
• Risk adjustment coding for Medicare, Commercial, and Medicaid lines of business.
• Compliance with client coding approaches and documentation standards.
• Proficient in English (reading and written communication required).
• Must be authorized to work in the United States.

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