This position is accountable for accurately reviewing, interpreting, auditing, coding and analyzing medical record documentation for diagnosis accuracy, correct documentation, and Hierarchical Coding Condition (HCC) abstraction.
Review may include inpatient, outpatient treatment and/or professional medical services, according to ICD-9/ICD-10 CM coding guidelines and risk adjustment model regulations.
This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual Risk Adjustment life cycle for the Medicare, Medicaid, and Commercial lines of business.
Can understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.
Review medical records for completeness, accuracy and compliance with applicable coding guidelines and regulations.
Identify, compile and code member/patient data, using ICD-9/ICD 10-CM and other standard classification coding systems.
Support the collection and distribution of documentation and coding improvement tools for designated practice units as applicable.
Support educational activities for internal stakeholders as necessary as subject matter expert on coding review/guidelines.
Actively participate & engage in program improvement discussions and activities.
Maintains department productivity and accuracy standards.