Senior Coder

About Us:

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact—whether we’re supporting data-driven decisions, modernizing systems or safeguarding critical programs.

Summary/Objective

Perform intake and coding validation on medical records and enter the corresponding data into CMS tool in accordance with contractual and organizational guidelines. Assist Project Director with any additional responsibilities requested.

Essential Functions

• Perform diagnosis coding of inpatient, outpatient, and physician office medical records per Risk Adjustment Data Validation (RADV) guidelines.
• Perform intake evaluation include validity status of medical records and attestations, non-compliance issues, and other validations checks as required per RADV guidelines.
• Perform Medical Record Dispute and Appeal reviews including technical writing per RADV guidelines.
• Provide Appeals support as RADV Subject Matter Expert at CMS request
• Participate and contribute to QA Panel discussions for medical record review intake/coding and appeals, as needed.
• Interact with the physician reviewer(s) as required.
• Answer questions from coders through the escalation process.
• Accurately enter data into encoder, CDAT-M, and other as required software using a personal computer, keyboard and/or mouse.
• Follow all established processes and procedures.
• Report problems to Project Director with regard to unique record or process issues.
• Maintain security and confidentiality of medical records and Protected Health Information (PHI)
• Consistently meet or exceed productivity and accuracy standards of 95% minimum IRR established by the customer and/or the company.
• Consistently meet attendance standards established by the Company.
• Interact appropriately with peers, co-workers, other Contractors, and the customer, when necessary. Contribute to building a positive team spirit.
• Assist Project Director with development of training materials.
• Assist with training and feedback of coders.
• Perform other duties and projects as assigned.