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Job Description:

Primary responsibilities:

• 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 model.
• Review medical record information to identify all appropriate HEDIS exclusion codes that do not map in the CMS HCC model.
• Review medical record information to identify all appropriate CPT II procedure coding
• Utilize medical coding software programs or reference materials to identify appropriate codes
• Complete appropriate system entry regarding claim/encounter information.
• Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable clinical codes
• Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
• 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/ACDIS compliant queries to providers when necessary
• Apply post-query response to make final determination
• Participate in ongoing training and education within assigned timeframe
• Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations
• Communicates to leadership issues and barriers to completing all work processesEducate and mentor others to improve medical coding quality

May participate in special project auditing as required

• All other duties as assigned by leadership

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