Coding Quality Review (CQR) Specialist

This is a remote position.

Location: Remote (U.S.-based only; Excludes CA, AK, NY, CO) The Coding Quality Review (CQR) Specialist is responsible for conducting high-quality audits of inpatient and outpatient medical coding across multiple HIM Service Centers (HSCs).

This fully remote role is instrumental in maintaining adherence to national coding guidelines and company policies while improving coder accuracy and reimbursement compliance.

Key Responsibilities Lead and perform internal coding quality reviews (routine, pre-bill, policy-driven, incentive-based) Audit inpatient MS-DRG medical records across all body systems Maintain coding accuracy (95% minimum) and productivity standards Participate in special audits and compliance projects Stay current on coding guidelines, data standards, and company policies Review and interpret multiple medical and regulatory resources for audit support Support coder education and development across HSCs Requirements Must-Have Qualifications (Strict Requirements) RHIA, RHIT, or CCS certification (Required) 3+ years of hands-on MS-DRG inpatient coding audit experience (Required) Experience auditing across all body systems (No specialization-only coders) Minimum 10+ years of total coding experience in a hospital setting Must meet 95% accuracy and productivity benchmarks Proficiency in current coding guidelines and compliance tools Strong attention to detail and ability to work independently in a virtual environment Note: Recent HIM grads and coders with no MS-DRG audit background will not be considered.

Preferred Qualifications Associates or Bachelors degree in Health Information Management (HIM) or Health Information Technology (HIT) Prior experience as a lead or educator in HIM coding QA/QC Familiarity with multi-facility audit processes or centralized coding platforms Experience participating in enterprise compliance audits or payer reviews
Bachelor's Degree in Business or related
5+ years
Required Qualifications Sales Experience: Minimum 1 year of successful B2B sales experience with proven quota achievement Communication: Excellent presentation and interpersonal skills Valid Florida driver's license and clean driving record Availability: Ability to travel extensively within Florida territory (up to 80%) Preferred Qualifications Education: Bachelor's degree preferred; life sciences background advantageous but not required Medical device, pharmaceutical, or healthcare sales experience Established relationships within Florida medical community Understanding of wound care, burn treatment, or reconstructive surgery Bilingual capabilities: Spanish/English and/or Creole/English