We are looking for experienced HCC SMEs and QA Analysts with hands-on expertise in CIYOX and Athena tools. The candidate will be responsible for ensuring coding accuracy, quality audits, and supporting team performance in Risk Adjustment (HCC) projects.
Key Responsibilities
For HCC SME:
Review and validate HCC coding as per CMS guidelines
Provide guidance and support to coders on coding queries and clarifications
Ensure accurate RAF score capture and documentation compliance
Train and mentor team members on coding standards and updates
Handle escalations and maintain productivity/quality benchmarks
For QA Analyst:
Perform quality audits on coded charts
Ensure adherence to coding guidelines (CMS/HCC standards)
Identify errors and provide constructive feedback to coders
Maintain audit reports, accuracy metrics, and dashboards
Conduct calibration sessions with SMEs and operations teams
Required Skills
Strong knowledge of HCC Coding & Risk Adjustment
Hands-on experience with CIYOX and Athena tools
Good understanding of ICD-10-CM guidelines
Strong analytical and auditing skills
Good communication skills (written & verbal)
Attention to detail and quality-focused mindset
Preferred Qualifications
Certification: CPC / CRC (preferred)
Experience in US Healthcare / Medical Coding
Key Performance Indicators (KPIs)
Maintain accuracy ≥ 95%
Meet productivity targets
Ensure low error rate in audits
Timely completion of feedback and reports
Salary
As per industry standards
Pay: ₹40,000.00 - ₹70,000.00 per month
Work Location: In person
