Medical Coder – Virtual Clinic (AWV & HEDIS Gap Closure) - Remote

About the role

The Medical Coder is responsible for accurate and compliant coding of telehealth encounters, with a primary focus on Medicare Annual Wellness Visits (AWVs) and HEDIS gap-closure services. This role ensures proper assignment of ICD-10, CPT, and HCPCS codes, supports quality-measure capture, and maintains compliance with CMS, HEDIS, and payer-specific requirements.

Responsibilities

• Develop and implement a compliant coding program in collaboration with CTH leadership to support accurate billing practices, audit readiness, and regulatory compliance.
• Encounter Coding and Review:
  • Assign appropriate ICD-10-CM diagnosis codes based on provider documentation.
  • Code CPT/HCPCS services for: Initial AWV (G0438) Subsequent AWV (G0439)
  • Ensure telehealth modifiers and place-of-service codes are correct.
• HEDIS Gap-Closure Coding:
  • Validate coding for HEDIS measures including CBP, EED, SPC, SUPD, OMW, BCS, GSD, KED, and COL.
  • Confirm diagnosis and procedure codes support measure closure.
  • Flag incomplete or non-compliant documentation.
• Documentation Audit:
  • Review charts for missing ICD-10 codes, incomplete AWV elements, and unsupported diagnoses.
  • Provide feedback to providers and nursing staff on documentation deficiencies.
• Compliance and Quality Assurance:
  • Ensure adherence to CMS, HEDIS, and telehealth coding guidelines.
  • Participate in internal coding audits and quality reviews.
• Provider and Staff Support:
  • Serve as a coding resource for providers, nurses, and quality teams.
  • Affiliate with coding education and documentation improvement.

Requirements

• Minimum 2 years outpatient or telehealth coding experience.
• Experience with Medicare AWV and HEDIS measures.
• Familiarity with telehealth billing rules.
• Preferred: Medicare Advantage or risk-adjustment experience, Experience in a virtual or high-volume clinic, Knowledge of CCM, RTM, or APCM programs.

Key Performance Indicators (KPIs)

• Coding accuracy rate ≥95%
• Charts coded within 24–48 hours
• Denial rate related to coding errors
• HEDIS gap closure supported by accurate coding

Core Competencies

• Strong CMS and HEDIS coding knowledge
• Attention to detail and compliance
• Independent remote work capability
• Strong communication with clinical teams

Technical Requirements

• Computer: Windows or Apple Computer ONLY (NO Chromebooks, Linux Machines, or Smartphones)
• Must have at least Windows 10 or MacOS 13.
• Headphones: Wired headphones required for optimal audio quality.
• Internet Speed: Meet minimum internet speed requirements (50 MBPS download speed and 20 MBPS upload speed), with a wired connection to the router.
• Must have an ethernet cable connecting computer directly into router
• Browsers and Systems: Use Google Chrome with Amazon Workspaces (regardless of computer type).
• Video Capability Required: Required for video calls. (Webcam)
• Laptops will come with a built-in webcam which is fine. If it doesn’t you’ll need to get one.
• Recommended Equipment: A second monitor is suggested for laptop users; dual monitors for PC users.