ROLE: AI-Risk Coding Associate
JOB TYPE: 6 MONTHS CONTRACT
SCHEDULE: GRAVEYARD SHIFT
LOCATION: TAGUIG, MANILA
KEY RESPONSIBILITIES
- 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.
JOB REQUIREMENTS and Qualifications
License / Certification: 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)
Education: Associate Degree or equivalent HCC coding experience
Skills:
- 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
Preferred Skills/Experience:
- 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
- 2 years risk adjustment coding experience preferred
