About the role
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