Remote Risk Adjustment Coder Jobs in Wilmington, DE

Job Details

Job Description

Position Summary

We are seeking an experienced Certified Outpatient Coder specializing in cardiac surgery to support accurate coding, billing, compliance, and revenue cycle integrity for a high-volume cardiovascular surgical program. This role is responsible for reviewing outpatient medical records and assigning appropriate ICD-10-CM, CPT, HCPCS, and modifier codes related to cardiac surgery procedures, diagnostic testing, and associated clinical services.

The ideal candidate has advanced knowledge of cardiovascular anatomy, cardiac surgical procedures, outpatient facility and/or professional fee coding guidelines, and payer-specific requirements. This position works collaboratively with physicians, APPs, clinical staff, billing teams, and revenue cycle leadership to ensure coding accuracy, optimize reimbursement, and maintain regulatory compliance.

Essential Responsibilities

• Review and accurately code outpatient cardiac surgery encounters, procedures, diagnostic studies, and related services using ICD-10-CM, CPT, and HCPCS coding systems.
• Assign appropriate modifiers and ensure compliance with NCCI edits, Medicare guidelines, and payer-specific rules.
• Interpret operative reports, physician documentation, catheterization reports, imaging studies, and procedural documentation related to cardiovascular surgery.
• Abstract coding and clinical data into the electronic medical record and billing systems.
• Identify documentation deficiencies and communicate with providers regarding clarification or education opportunities.
• Maintain productivity and quality standards established by department leadership.
• Support denial management and appeals by reviewing coding-related denials and providing corrective recommendations.
• Participate in internal coding audits, compliance initiatives, and process improvement efforts.
• Remain current on coding updates, payer regulations, and cardiovascular coding changes.
• Collaborate with cardiac surgery leadership, revenue cycle teams, and compliance departments to improve coding accuracy and charge capture.

Required Qualifications

• High school diploma or equivalent required; Associate's degree preferred.
• Current coding certification required, including one of the following:
  • AAPC Certified Professional Coder (CPC)
  • AHIMA Certified Coding Specialist (CCS)
  • Certified Outpatient Coder (COC) preferred.
• Minimum of 3 years of outpatient coding experience required.
• Minimum of 2 years of cardiovascular or cardiac surgery coding experience strongly preferred.
• Strong knowledge of:
  • ICD-10-CM
  • CPT and HCPCS coding
  • Cardiac surgery terminology and anatomy
  • Medicare and commercial payer regulations
  • Outpatient facility and/or professional fee coding guidelines
• Experience with Epic and encoder software preferred.
• Excellent analytical, organizational, and communication skills.
• Ability to work independently while maintaining high accuracy and productivity standards.

Preferred Experience

• Coding experience in:
  • CABG procedures
  • Valve repair/replacement
  • TAVR/TMVR
  • ECMO
  • Thoracic aortic procedures
  • Minimally invasive cardiac surgery
  • Cardiac outpatient testing and follow-up procedures
• Experience supporting academic medical centers or large cardiovascular programs preferred.

Knowledge, Skills, and Abilities

• Advanced understanding of cardiovascular procedural documentation.
• Strong attention to detail and critical thinking skills.
• Ability to prioritize workload in a fast-paced healthcare environment.
• Strong interpersonal skills and ability to collaborate across multidisciplinary teams.
• Commitment to confidentiality, compliance, and coding integrity.

Working Conditions

• Hybrid or remote work eligibility based on organizational policy and performance standards.
• Prolonged computer use and sedentary work environment.
• May require occasional attendance at departmental meetings or educational sessions.

Sample Performance Metrics

• Coding accuracy rate 95%
• Timely completion of assigned work queues
• Denial reduction and resolution support
• Compliance with departmental productivity standards

Work Shift

Worker Sub Type

Employee Entity

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time(including per diemcolleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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