Medical Coder HCC

Role Overview:

As an HCC Coder in Mumbai, your primary responsibility will be to review and analyze patient medical records for accurate assignment of ICD-10-CM diagnosis codes following CMS-HCC risk adjustment guidelines. Your focus will be on ensuring proper documentation, compliance, and precise Risk Adjustment Factor (RAF) scoring for reimbursement purposes.

Key Responsibilities:

• Review patient medical records across various settings such as outpatient, inpatient, and home health, and assign accurate ICD-10-CM codes based on clinical documentation.
• Map diagnosis codes to appropriate HCC categories for risk adjustment coding projects as per CMS guidelines.
• Ensure accurate capture of chronic and high-risk conditions affecting RAF scores by applying knowledge of disease hierarchy and HCC models.
• Validate documentation to ensure all coded diagnoses meet MEAT (Monitor, Evaluate, Assess, Treat) criteria and identify any incomplete or insufficient documentation.
• Adhere to CMS-HCC coding guidelines, maintain high coding accuracy, and quality benchmarks while participating in internal and external audits.
• Meet daily coding targets and turnaround time (TAT) by balancing productivity and accuracy.
• Collaborate with QA teams, auditors, and team leads to address feedback and enhance coding performance.
• Stay updated with annual ICD-10-CM changes and CMS-HCC model updates through training and skill enhancement programs.

Qualification Required:

• Bachelor's degree in Life Sciences, Nursing, Pharmacy, or related field. Medical coding certification or diploma is preferred.
• Preferred certifications: CPC, CCS, CRC.
• Minimum 12 years of experience in medical coding with prior experience in HCC or risk adjustment coding.
• Strong knowledge of ICD-10-CM coding guidelines, understanding of HCC, RAF, and CMS regulations, good grasp of medical terminology and anatomy, ability to analyze clinical documentation with precision, high attention to detail, accuracy, good communication, and teamwork skills.

(Note: No additional details of the company were provided in the job description.) Role Overview:

As an HCC Coder in Mumbai, your primary responsibility will be to review and analyze patient medical records for accurate assignment of ICD-10-CM diagnosis codes following CMS-HCC risk adjustment guidelines. Your focus will be on ensuring proper documentation, compliance, and precise Risk Adjustment Factor (RAF) scoring for reimbursement purposes.

Key Responsibilities:

• Review patient medical records across various settings such as outpatient, inpatient, and home health, and assign accurate ICD-10-CM codes based on clinical documentation.
• Map diagnosis codes to appropriate HCC categories for risk adjustment coding projects as per CMS guidelines.
• Ensure accurate capture of chronic and high-risk conditions affecting RAF scores by applying knowledge of disease hierarchy and HCC models.
• Validate documentation to ensure all coded diagnoses meet MEAT (Monitor, Evaluate, Assess, Treat) criteria and identify any incomplete or insufficient documentation.
• Adhere to CMS-HCC coding guidelines, maintain high coding accuracy, and quality benchmarks while participating in internal and external audits.
• Meet daily coding targets and turnaround time (TAT) by balancing productivity and accuracy.
• Collaborate with QA teams, auditors, and team leads to address feedback and enhance coding performance.
• Stay updated with annual ICD-10-CM changes and CMS-HCC model updates through training and skill enhancement programs.

Qualification Required:

• Bachelor's degree in Life Sciences, Nursing, Pharmacy, or related field. Medical coding certification or diploma is preferred.
• Preferred certifications: CPC, CCS, CRC.
• Minimum 12 years of experience in medical coding with prior experience in HCC or risk adjustment coding.
• Strong knowledge of ICD-10-CM coding guidelines, understanding of HCC, RAF, and CMS regulations, good grasp of medical terminology and anatomy, ability to analyze clinical documentation with precision, high attention to detail, accuracy, good communication, and teamwork skills.

(Note: No additional details of the company were provided in the job description.)