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Coding Compliance Specialist

J29, IncMillersville, MD
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Overview

Schedule
Flexible-schedule
Part-time
Education
Health Information (RHIA, RHIT)
Medical Coding (CCA, CCS, CCS-P, CPC)
Career level
Senior-level
Remote
Remote
Benefits
Flexible/Unlimited PTO
Career Development

Job Description

*Candidate must have direct experience working on the Centers for Medicare & Medicaid Services Risk Adjustment Data Validation (CMS RADV) contract.*Day time availability is required due to meetingsPosition Summary 

The Coding Compliance Specialist is responsible for overseeing and evaluating assigned Risk Adjustment Data Validation (RADV) medical record review (MRR) work performed under the contract. This role ensures compliance with CMS RADV guidelines, coding standards, and risk adjustment policies while maintaining the highest quality and accuracy in medical record documentation. This is a part-time, remote position with flexible scheduling, ideal for experienced professionals seeking autonomy and work-life balance. 

Key Responsibilities 

  • Ensure adherence to CMS RADV payment and risk adjustment policies. 

  • Provide expert guidance on coding and documentation standards, including ICD-CM, HCC, and Risk Adjustment. 

  • Review escalated Medicare RADV medical record cases and resolve complex issues. 

  • Maintain quality assurance and compliance across all RADV review activities. 

  • Collaborate with stakeholders to improve processes and ensure contractual obligations are met. 

  • Conduct medical record, coding, and policy research. 

  • Develop and deliver training programs related to RADV and coding compliance. 

  • Perform medical record reviews involving PHI/PII, identify conflicting documentation, and provide coding clarifications. 

Experience Requirements 

  • Prior experience working directly on the CMS RADV contract is required  

  • Minimum 5 years of supervisory experience in medical record review, preferably RADV. 

  • Proven expertise in reviewing escalated Medicare RADV medical record cases. 

  • In-depth knowledge of RADV Medical Record Review (MRR) processes, ICD-CM coding standards, CMS RADV payment and risk adjustment policies, and documentation guidelines. 

Education & Certification 

  • Medical Coding Certification from an accredited entity (e.g., AAPC, AHIMA). 

  • RHIT, RHIA, CCS, CPC, CRC 

  • Advanced knowledge of coding systems and compliance regulations. 

Skills & Competencies 

  • Strong analytical and problem-solving skills. 

  • Excellent communication and leadership abilities. 

  • Detail-oriented with a commitment to accuracy and compliance. 

  • Ability to manage multiple priorities and meet deadlines. 

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FAQs About Coding Compliance Specialist Jobs at J29, Inc

What is the work location for this position at J29, Inc?
This job at J29, Inc is located in Millersville, MD, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at J29, Inc?
Employer has not shared pay details for this role.
What employment applies to this position at J29, Inc?
J29, Inc lists this position under the following employment categories:
  • Flexible-schedule
  • Part-time
What experience level is required for this role at J29, Inc?
J29, Inc is looking for a candidate with "Senior-level" experience level.
Does J29, Inc allow remote work for this role?
Yes, this position at J29, Inc supports remote work, giving candidates the flexibility to work outside the primary office location.
What education level is required for this job?
The education requirement for this position includes Health Information (RHIA, RHIT) and Medical Coding (CCA, CCS, CCS-P, CPC). Candidates with relevant qualifications or equivalent experience may also be considered.
What benefits are offered by J29, Inc for this role?
J29, Inc offers following benefits: Flexible/Unlimited PTO and Career Development for this position. Actual benefits may vary depending on the employer's policies and employment terms.
What is the process to apply for this position at J29, Inc?
You can apply for this role at J29, Inc either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.