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Senior Certified Professional Coder

The Senior Certified Professional Coder oversees the medical record coding and coding process for all records reviewed for Risk Adjustment. This includes records received for other plan purposes such as claims review, HEDIS, appeals and medical management.

  • Act as a Subject Matter Expert on HCC coding for MHI.
  • Act as a mentor to junior coders where appropriate.
  • Coordinates and performs over-read activities for vendor coding of all chart audit projects.
  • Collaborates with and maintains external partner relationships, including but not limited to providers and vendors.
  • Collaborates with internal departments as necessary (Member Services, Information Systems, Claims, Utilization Management, Medical Management, Actuarial and Pharmacy) to ensure the timely review of all medical records deemed necessary for coding.
  • Develops and Maintains MHI coding policies in accordance with industry standards and CMS guidelines.
  • Assists Risk Adjustment Manager in developing appropriate coding operations for all Risk Adjustment initiatives. Initiate process improvements when required.

  • AAPC CPC or CRC, or AHIMA CCA certification.
  • Three to five years of experience medical record coding.
  • One to three years of experience HCC coding.
  • One to two years over-read experience.
  • Experience with chart audit vendors.
  • Knowledge of Risk Adjustment principals (MA or ACA).
  • Excellent verbal, written and interpersonal communications skills.
  • Ability to manage multiple projects and deadlines simultaneously.
  • Sound judgment and ability to process complex information quickly and thoroughly.

Description of Company:

Minuteman Health is a non-profit health insurance option for Massachusetts and New Hampshire residents. Founded by contributors that include Tufts Medical Center, Vanguard Health Systems and New England Quality Care Alliance (NEQCA), Minuteman offers consumers and employers lower-cost high-quality care with unprecedented transparency, as well as increased efficiency and satisfaction for physicians, patients, and employers alike. Plan members will ultimately govern this health plan via Minuteman’s unique ownership structure.

*Please, NO recruiters or agencies