Join a leading healthcare services organization and take ownership of complex case reviews—all from home.
About Maximus
Maximus provides essential services to help governments improve program efficiency and deliver better outcomes. We specialize in health and human services programs and offer innovative solutions that support communities and individuals across the United States.
Schedule
- Full-time, fully remote position
- Flexible work hours to support work/life balance
- Company-issued computer equipment provided
- Reliable high-speed internet required (minimum 20 Mbps download / 5 Mbps upload; 50 Mbps for shared connections)
Responsibilities
- Audit medical records for compliance with Medicare Advantage Risk Adjustment standards, including abstraction and accurate coding based on clinical data
- Assign and verify CPT, HCPCS, and ICD-10-CM codes using industry-standard billing guidelines
- Apply California Workers’ Compensation regulations and calculate fee schedule allowances
- Evaluate the accuracy and appropriateness of coded and billed medical information
- Develop final determination letters based on regulatory and clinical standards
- Research coding practices, document findings, and share with team members
- Train staff on coding processes (both project-specific and general)
- Perform QA audits on coding processes and recommend improvements
- Collaborate virtually with cross-functional teams to ensure quality and compliance
- Perform other duties as assigned by management
Requirements
- High school diploma or equivalent with 4+ years of experience, or associate degree with 2+ years of experience
- CPC, CCS, or RHIT certification required
- Experience coding physician, inpatient, and/or outpatient medical records
- Preferred experience auditing inpatient and outpatient records for risk adjustment
- Strong writing and critical thinking skills
- Proficiency in Word, Excel, and Outlook
- Mathematical skills: ability to add, subtract, multiply, and divide using whole numbers, fractions, and decimals
Preferred Qualifications
- Bachelor’s degree from an accredited institution
- Experience as a medical claim examiner, reviewing physician and hospital PPO contracts
- Familiarity with California Workers’ Compensation Official Medical Fee Schedule
- Knowledge of CMS payment methodologies: IPPS, OPPS, DMEPOS, and Physician Fee Schedule
Benefits
- Competitive hourly pay range: $28.03 – $37.40
- Medical, dental, vision, prescription coverage, and partially funded HSA
- Life insurance plus optional auto, home, renter’s, and pet insurance
- 401(k) retirement savings plan with company match
- Paid time off, holidays, extended sick leave, short- and long-term disability
- Employee Assistance Program for physical, emotional, and financial wellness
- Tuition reimbursement and professional development opportunities
- Licensure and certification renewal costs covered
- Employee perks, discounts, and recognition programs
Happy Hunting,
~Two Chicks…