Clinical Coder, Full-Time, Hybrid

At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.

Central Maine Healthcare is seeking a remote Clinical Coder to join our Accountable Care Organization Team.

This is a full time, benefits eligible position. ​Need to be available to attend occasional meetings and trainings.

Starting pay is $23.75 per hour.

The Clinical Coder will be responsible for reviewing Central Maine ACO providers’ medical record documentation to ensure use of accurate medical coding of all professional, inpatient and outpatient services, procedures, diagnoses and conditions in support of complete and accurate risk adjustment revenue for applicable ACO populations. The coder will review provider documentation of ICD-9-CM/ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment guidelines. The coder will lead efforts to evaluate the HCC coding practices and provide analyses and recommendations to improve overall provider documentation and coding. The Risk Adjustment Coding Auditor will review medical records to determine if diagnostic codes (ICD-9-CM/ICD-10-CM) are accurately reflecting the provider documentation. The coder will summarize findings for internal and external parties.

Education and Experience:

• Bachelor’s Degree or combination of relevant education and experience
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS); Certified Risk Adjustment Coder (CRC) preferred
• 2+ years of billing/coding experience in a medical/surgical or facility setting
• Knowledge of diagnoses/procedures in accordance with ICD-9/10-CM coding principles for HCC coding
• Experience with CMS Medicare Advantage Risk Adjustment preferred
• Ability to work with physicians and care team staff in a collaborative manner

What It’s Like Working At CMH: 

We are all about our team members growth and health. That why we prioritize work/life balance, community-based wellness initiatives and tuition reimbursement or student loan repayment for ALL of our team members. 

CMH offers a robust benefits package that includes: 

• Robust Paid Time Off (PTO) program 
• Medical plan with enhanced Tier 1 benefits provided within the CMH system. 
• Dental plan 
• Vision plan 
• Health Savings Account (HSA) 
• Basic Life insurance at no cost 
• Supplemental Life insurance 
• Long-term disability insurance 
• 401(k) or 403(b) retirement savings plans 
• Tuition IO partnership for student loan repayment assistance and tuition assistance 
• Family leave program for Parental Leaves 
• Comprehensive Wellness Program 

Essential Duties:

• Accurately and efficiently reviews medical charts and assigns the correct diagnosis (ICD-9/10 CM), procedure (CPT), and supply (HCPCS Level II) code for a wide variety of clinical cases and services.
• Identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories.
• Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.
• Review medical record information to identify all appropriate coding based on CMS HCC categories.
• Effectively communicates with physicians in order to clarify diagnoses/procedures and sequencing of diagnoses.
• Utilizes specialized coding knowledge and auditing skills to achieve established coding quantity and quality standards.
• Assesses medical coding practices and suggests areas of improvement for follow up physician training and communication.
• Performs other duties as assigned.

If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!