KEY RESPONSIBILITIES
- Assigns Diagnosis Codes: Utilizes the Official ICD-10-CM Guidelines for Coding and Reports to accurately map conditions to the CMS-Hierarchical Condition Categories (CMS-HCC) for the applicable service year(s).
- Reviews Medical Charts: Effectively employs computer-assisted coding tools to review and interpret medical records, applying a deep understanding of coding principles to assign validated diagnosis codes supported by medical record evidence from the same service date.
- Upholds Medical Record Integrity: Ensures all coding supports CMS-HCC requirements, including adherence to signature guidelines, recognition of member identifiers, provider types, and medical visit types, ensuring accuracy across all service locations.
- Medical Knowledge Application: Demonstrates profound knowledge of medical terminology, anatomy, and physiology relevant to code assignment and identification of crucial supporting information within medical records.
- Quality and Productivity Management: Maintains high standards of work quality and productivity, striving to meet or exceed set targets.
- Administrative Support: Carries out administrative duties as directed by the Team Lead, Operations Lead, or Quality Lead.
- Collaboration and Consultation: Provides timely consultation to the Team Lead, Operations Manager, or Coding SME as required.
JOB REQUIREMENTS and Qualifications
- Education: Requires an Associate Degree or equivalent experience in HCC coding.
- Skills:
- Proficient in Microsoft Windows, MS Office, and internet use.
- Skilled in using ICD-10-CM code books or Encoder software aligned with the service date to accurately assign diagnosis codes per official guidelines.
- Well-versed in ICD-10-CM outpatient diagnosis coding guidelines.
Preferred Skills/Experience:
- Hierarchical Condition Code Knowledge: Understands Hierarchical Condition Code concepts thoroughly.
- HIPAA Compliance: Committed to ensuring the privacy, security, and confidentiality of all medical records and member information.
- Risk Adjustment Expertise: Demonstrated understanding of CMS HCC Risk Adjustment coding and data validation requirements.
- EHR/EMR Proficiency: Preferred experience with Electronic Health/Medical Record systems.
