The Clinical Coder & Data Entry Coordinator will report directly to the Risk Adjustment Manager & work directly with the Risk Adjustment Lead HCC Clinical Coder. The Clinical Coder will perform accurate and timely coding review and validation of HCC’s through medical records. The Coder will document ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment Guidelines. Once the ICD-10 codes have been documented data entry will be required to submit claims to the plans 3rd party administrator claims system for adjudication of that claim. The Clinical Coder will assist the Risk Adjustment Lead HCC Clinical Coder with projects assigned which will include develop coding related documentation/policies specific to all Medicare & Medicaid Risk Adjustment criteria.
Will also be responsible for timely completion of projects, including timeline development & maintenance as it pertains to encounter data.
Correct encounter rejects as pertaining to HCC coding issues
Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered
Document and present findings to Manager
Must be a certified coder CPC, CCS, CCS-P or other Allied Health credentials & a minimum of three (3) years with demonstrated sustained coding quality
Previous experience reviewing medical records for appropriateness code assignment
Knowledge of ICD-10 and CPT coding guidelines and knowledge State and Federal regulations
Experience in HCC coding in a managed care setting