The posting
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Lead Senior Coder QA based in United States.
This role combines advanced medical coding expertise with quality assurance, dispute review, and team leadership. You will validate inpatient, outpatient, and physician medical records in accordance with Risk Adjustment Data Validation (RADV) guidelines. The position serves as a quality and escalation resource, ensuring coding accuracy, consistency, productivity, and regulatory compliance. You will lead and support a team of up to 15 primary and senior coders while providing guidance, feedback, and training. The role also involves complex appeals and dispute reviews, coder QA, process oversight, and collaboration with project leadership. Confidentiality and the secure handling of medical records and Protected Health Information (PHI) are essential to the position. This is a fully remote opportunity suited to an experienced certified coder who can serve as a trusted subject matter expert and coding quality standard.
Accountabilities:
- Perform primary and secondary coding validation reviews of inpatient, outpatient, and physician office medical records in accordance with RADV guidelines and applicable coding standards.
- Conduct intake evaluations, including medical record validity, attestation status, non-compliance issues, and other required validation checks under RADV requirements.
- Perform medical record dispute and appeal reviews, ensuring coding decisions are accurate, well-supported, and compliant with established guidelines.
- Conduct quality assurance reviews of coder work and provide timely feedback, coaching, and training to improve accuracy and consistency.
- Lead and support a team of up to 15 primary and senior coders, providing day-to-day guidance, answering coding questions, and supporting team performance.
- Mediate coding decisions between primary and senior coders, provide appropriate feedback, and serve as an escalation point for complex coding questions.
- Accurately enter and maintain coding data using encoder, CDAT-M, and other required software applications.
- Follow established processes and procedures, identify unique record or process issues, and report problems to project leadership when appropriate.
- Maintain strict security and confidentiality of medical records and Protected Health Information (PHI).
- Consistently meet or exceed established productivity and accuracy expectations, including a minimum 95% IRR standard.
- Support the development of training materials and assist with onboarding and training new coders.
- Promote positive collaboration and professional relationships with peers, colleagues, contractors, and customers when required.
- Support project leadership with additional duties and initiatives as assigned.
- Active certification as a medical coder from a recognized United States medical coding credentialing institution is required.
- At least 5 years of experience abstracting and coding general acute hospital inpatient and outpatient records, as well as physician medical records, using ICD-9/ICD-10-CM coding guidelines and applicable Official Coding Clinics.
- Demonstrated ability to function effectively in a lead capacity and train medical record reviewers or coding professionals.
- Strong knowledge and expertise to serve as a “Master Coder” or gold-standard coding resource across medical record coding projects.
- Thorough understanding of inpatient and outpatient coding practices, RADV requirements, coding validation, and medical record review.
- Strong quality assurance, analytical, problem-solving, and decision-making skills, particularly when resolving complex or disputed coding determinations.
- Ability to communicate clearly, provide constructive feedback, answer escalated questions, and support the development of other coders.
- Strong attention to detail and commitment to maintaining high standards of coding accuracy, productivity, compliance, and confidentiality.
- Ability to work effectively in a fully remote environment while maintaining established attendance, productivity, and quality expectations.
- High level of professionalism when interacting with internal teams, contractors, project leadership, and customers.
- Annual salary of $65,000–$75,000, with actual compensation determined by factors such as skills, experience, qualifications, certifications, location, organizational needs, and applicable employment laws.
- Fully remote work arrangement within the United States.
- Full-time employment.
- Opportunity to take on a lead-level role combining coding expertise, QA, training, escalation management, and team leadership.
- Responsibility for supporting and mentoring a team of up to 15 coders.
- Exposure to complex medical record validation, RADV requirements, dispute and appeal reviews, and quality assurance.
- Opportunity to contribute to training materials, process improvement, and project-level initiatives.
- Additional employee benefits are available as part of the overall compensation package.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Why Apply Through Jobgether?
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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