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Medical coder

Avenue Code, LLCUnited States🇺🇸United StatesPosted Sep 18, 2026

Quick Overview

Seniority
Mid Senior
Work mode
Remote
Location
United States
Posted
3 days ago
ICD-10

Job Description

Senior Coder
Remote
 
Key Responsibilities
  • Perform diagnosis code abstraction on original medical record reviews, applying ICD-10-CM coding guidelines (and ICD-9-CM for records with dates of service through September 30, 2015) in accordance with CMS-approved RADV workflows.
  • Serve as the primary escalation point for Mid-Level Coders, resolving complex, ambiguous, or discrepant intake and coding issues forwarded during initial review.
  • Perform appeals-related diagnosis abstraction, incorporating additional documentation and context supplied by the Medicare Advantage Organization to determine whether audited HCCs are substantiated.
  • Adhere strictly to the SOW's separation-of-review requirement during appeals: coders may not review the same medical record during appeals that they reviewed during the original abstraction.
  • Provide professional-quality editorial review of appeal coders' written submissions, ensuring clarity, structural consistency, and defensibility of updated coding summaries before they are sent to the RADV Appeals Support Contractor.
  • Validate that documentation genuinely supports the diagnosis codes assigned, applying sound clinical and coding judgment consistent with CMS-HCC hierarchy logic.
  • Consult with the Physician Consultant on complex clinical documentation questions arising during abstraction or appeals review.
  • Support quality assurance sampling and inter-rater reliability (IRR) reviews as directed by the Lead Senior Coder, QA.
  • Maintain a minimum 95% individual accuracy rate across all review types (intake, abstraction, and appeals).
  • Contribute workflow and reporting improvement recommendations to CDAT-M based on patterns observed in escalated and appealed cases.
  • Attend required CMS and RADV Independent Coding Consultant (ICC) training sessions and maintain current knowledge of evolving RADV audit methodology and coding guidance.
  • Handle protected health information (PHI) and other sensitive data in strict compliance with HIPAA, CMS data confidentiality requirements, and contract-specific Data Use Agreement terms.
Requirements
  • Active, valid coding certification from AHIMA or AAPC, one of the following: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Risk Adjustment Coder (CRC), Certified Coding Associate (CCA), or Certified Coding Specialist (CCS).
  • Minimum of 5 years of professional coding experience, with demonstrated proficiency in both ICD-9-CM and ICD-10-CM coding guidelines.
  • Demonstrated experience resolving complex or disputed coding determinations, ideally including formal escalation, quality review, or appeals-related coding work.
  • Experience coding across multiple sites of service (hospital inpatient, hospital outpatient, and physician office settings).
  • Strong written communication skills, with demonstrated ability to produce clear, well-organized coding rationale suitable for submission in a formal appeals or audit context.
  • Ability to pass a federal background investigation and obtain the position-appropriate personnel security clearance/credential required for CMS system access (PIV or equivalent).
  • Comfortable working in a fully remote, virtual-meeting environment using standard CMS-approved collaboration and secure data-exchange tools.
Preferred Qualifications
  • Prior experience with CMS Risk Adjustment programs, RADV, HCC coding, or Medicare Advantage payment methodology.
  • Prior experience specifically in a coding appeals, dispute resolution, or medical record review escalation role.
  • Experience with CDAT-M or similar federal medical record review platforms.
  • Bilingual Spanish/English coding capability.

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