Assigns diagnosis codes according to the Official ICD-10-CM Guidelines for Coding and Reports for conditions which map to the Center for Medicare & Medicaid Services Hierarchical Condition Categories (CMS-HCC) applicable for the year(s) of service being reviewed
Conducts thorough review of charts by effectively using computer-assisted coding tools to review and interpret medical records, and applies in-depth knowledge of coding principles to assign valid diagnosis codes which are supported by evidence in the medical record on the same date of service
Demonstrates knowledge of what constitutes a medical record acceptable for supporting CMS-HCCs, including signature guidelines, member identifiers, provider types, medical record encounter/visit types, and places of service
Demonstrates advanced knowledge of medical terminology, anatomy and physiology as they pertain to assigning appropriate codes and identifying pertinent supporting information in the medical record
Manages individual quality of work & productivity toward meeting or exceeding targets.
Performs administrative tasks and work as directed by Team Lead/Operations Lead/Quality Lead.
Consults Team Lead/Operations Manager and/or Coding SME timely and appropriately.
Qualifications
The ideal candidate must possess a Bachelor of Science in Nursing, Other Allied Health graduate, Associate Degree or equivalent HCC coding experience
Must holds and maintains active Certified Professional Coder (CPC) and/or Certified Risk Adjustment Coder (CRC) certification through the American Academy of Professional Coders OR Certified Coding Specialist (CCS) and/or Certified Coding Specialist Physician based (CCS-P) through American Health Information Management Association (AHIMA)
Must have 2 years of experience in risk adjustment coding
Knowledge of Hierarchical Condition Code concepts
Knowledge of HIPAA, recognizing a commitment to privacy, security and confidentiality of all medical records and member information
Knowledge and demonstrated understanding of CMS HCC Risk Adjustment coding and data validation requirements preferred
EMR/EHR experience preferred
Related outsourcing/vendor operations experience preferred
Computer proficiency (including MS Windows, MS Office, and the internet)
Ability to use an official ICD-10-CM code book or Encoder software which corresponds to the date(s) of service being reviewed to assign diagnosis codes appropriately and according to official guidelines and section/chapter level instructions
Knowledge of and ability to apply ICD-10-CM outpatient diagnosis coding guidelines
Must be amenable to undergo 2 weeks of face-to-face training in BGC, Taguig. After training, will then proceed to a hybrid setup.
