Medical Coder - State Arbitration

Description & Requirements

Maximus is currently hiring for a Medical Coder to join our NY State Arbitration team.

This is a remote opportunity.

The Medical Coder is responsible for completing retrospective reimbursement reviews which includes reviewing services rendered and determining a reasonable reimbursement.

They will make final determinations and craft a written determination letter that is final and binding.

The Medical Coder must be comfortable working in a fast paced, deadline driven environment.

Essential Duties and Responsibilities:
- Audit medical records to ensure compliance with the Medicare Advantage Risk Adjustment standards including abstraction and assignment of appropriate codes based on clinical data.
- Enter coded data into a system accurately and validate date entered.
- Research correct coding practices, clearly document and share findings with others.
- Write clear and concise rationales that provide defensible support of decisions.
- Train staff members on the coding processes (both project specific and general coding).
- Perform QA audits on coding process.
- Recommend and suggest improvements to assigned projects.
- Perform other duties as assigned by management.

Minimum Requirements

- High school diploma or equivalent with 4+ years of experience, or AA with 2+ years of experience.
- Preferred risk adjustment auditing experience of coding inpatient and outpatient medical records.
- CPC, CCS, or RHIT Certification required.
- Ability to use critical thinking skills.
- Must have excellent writing skills.

- Ability to work a training schedule of 8:30am - 4:30pm EST Monday - Friday required.

- Knowledge of Medical Billing and Coding Systems such as ICD-10-CM, CPT, and HCPCS highly preferred.

- Familiarity with reimbursement for services rendered highly preferred.

- Understanding of the No Surprises Act and its implications for billing practices preferred.

Please note: For this position Maximus will provide equipment to use.

Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce.

We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country.

We're proud of our connections to organizations dedicated to serving veterans and their families.

If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the...