- Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered.
- Review medical record information to identify all appropriate coding based on CMS HCC categories.
- Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
- Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
- Support and participate in process and quality improvement initiatives.
- Maintain a comprehensive tracking and management tool to track all HCC activities and ensure that all tasks are completed in a timely manner.
- Performs AHIMA compliant queries to providers when necessary
- Participate in ongoing training and education
- May participate in special project auditing as required
- Assists with the auditing, and oversight of Coders
- Minimum Experience
- 3+ years of coding experience (CPT, ICD-9/10, HCPCS)
- Risk Adjustment and/or HEDIS experience preferred
- Minimum of High School Diploma
- Associates Degree or bachelor’s degree preferred
- One of the following Coding Certification CCS, CCS-P, CCA through AHIMA or CPC, COC, CIC through AAPC) required
- Additional CRC certification required
- Additional RHIA and /or RHIT preferred
