AHIPL Agilon Health India Private Limited
India_Bangalore
Medical Coder
Primary responsibilities:
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Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered.
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Review medical record information to identify all appropriate coding based on CMS HCC model.
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Review medical record information to identify all appropriate HEDIS exclusion codes that do not map in the CMS HCC model.
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Review medical record information to identify all appropriate CPT II procedure coding
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Utilize medical coding software programs or reference materials to identify appropriate codes
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Complete appropriate system entry regarding claim/encounter information.
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Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable clinical codes
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Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
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Maintain a comprehensive tracking and management tool to track all HCC activities and ensure that all tasks are completed in a timely manner.
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Performs AHIMA/ACDIS compliant queries to providers when necessary
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Apply post-query response to make final determination
- Participate in ongoing training and education within assigned timeframe
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Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations
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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
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All other duties as assigned by leadership
India_Bangalore
