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Certified Coder - Hybrid

Date:  Aug 6, 2022

Any city, AK, US, 99999

Req ID:  11645

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS, a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.


HMS is hiring individuals for our Certified Coder positions. The Certified Professional Coders are responsible for auditing inpatient and/or outpatient medical records as part of our payment accuracy or fraud, waste, and abuse products. These positions also support internal departments with review and support of claims research. These reviews determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately document findings and providing policy/regulatory support for determination. The candidates must have an extensive background in either facility-based inpatient coding and/or outpatient coding edits and a high level of understanding in reimbursement guidelines.

Your role in our mission



•    Performs audits of medical record documentation to determine the accuracy of billed procedure and diagnosis codes. 
•    Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Draws on advanced ICD-10 coding and/or CPT and HCPC coding expertise, as well as industry knowledge, to substantiate conclusions. Utilizes HMS proprietary auditing systems with a high level of proficiency to document audit determinations and rationale. 
•    Assists in the development and testing of new audit concepts or tools.
•    Contributes new ideas for improving existing audit processes to optimize efficiency and quality.
•    Assists with training to include monitoring, mentoring, feedback, and education.
•    Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification. 
•    Attends training and scheduled meetings to enhance skills and working knowledge of coding policies, procedures, and guidelines.
•    Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.


What we’re looking for


•    CPC required. Demonstrated experience with coding systems, and demonstrated knowledge of medical codes, coding conventions, and rules. 
•    Two or more years of medical record coding experience, preferably in a hospital setting
•    One year or more of medical record auditing/validation experience required
•    Demonstrated proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodologies. Working knowledge of HIPAA Privacy and Security Rules.
•    Demonstrated ability to write clear, accurate, and concise rationales in support of finding, and ability to build relationships both internally and externally.



What you should expect in this role

Work from Home or Hybrid
Work-from-home (WFH); or Hybrid model including in-office and WFH days to be defined. For positions assigned to WFH, reliable high-speed internet connectivity is required.  Employees working-from-home may be required to report to the office, at times, to support work efforts.  


The pay range for this position is $48,000.00 - $60,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at HMS, a Gainwell Company. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.


We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with HMS, a Gainwell Company, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about HMS, A Gainwell Technologies Company at our company website and visit our Careers site for all available job role openings.


HMS, a Gainwell Company is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

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