HCC / Risk Adjustment Medical Coders
- Job Description:
- Review and accurately code medical records and encounters for diagnoses and procedures related to Risk Adjustment and HCC coding guidelines.
- Ensure coding is consistent with ICD-10-CM, CMS-HCC, and other relevant coding guidelines.
- Validate and ensure the completeness, accuracy, and integrity of coded data.
- Identify and resolve coding discrepancies or discrepancies between clinical documentation and diagnosis coding.
- Stay up-to-date with the latest coding guidelines, rules, and regulations related to Risk Adjustment and HCC coding.
- Adhere to all compliance and HIPAA regulations to maintain data security and patient confidentiality.
- Collaborate with healthcare providers, physicians, and other team members to clarify documentation and resolve coding queries.
- Participate in coding education and training programs to enhance coding skills and knowledge.
- Prepare and submit reports related to coding activities, coding accuracy, and any coding-related issues or trends.
- Assist in internal and external coding audits to ensure the quality and compliance of coding practices.
- Identify opportunities for process improvement and efficiency in the coding process.
- Offer suggestions to enhance coding documentation and accuracy.
- Requirements:
- Minimum CPC or CCS certification from AHIMA or AAPC is required. Higher-level certifications such as CRC (Certified Risk Adjustment Coder) is a significant advantage. CPC-A (Apprentice) certification will not be considered for this position.
- Minimum one to two years of experience in Risk Adjustment and HCC coding in a healthcare setting.
- Strong knowledge of ICD-10-CM coding guidelines and CMS-HCC risk adjustment methodology.
- Familiarity with electronic health record (EHR) systems and coding software.
- Excellent attention to detail, analytical skills, and ability to work independently.
- Strong communication and interpersonal skills for collaboration with medical professionals and team members.
- Understanding of compliance and confidentiality regulations, including HIPAA.
