The HCC Coder evaluates patient medical records, charts, and encounters to capture all reportable chronic conditions and active diagnoses. The ideal candidate maintains high levels of coding accuracy, ensures strict compliance with CMS guidelines and HIPAA, and collaborates with medical staff to resolve documentation gaps.
Key Responsibilities
- Chart Abstraction & Coding: Review outpatient/inpatient electronic health records (EHR) and abstract ICD-10-CM codes for chronic conditions according to Official Coding Guidelines and CMS Risk Adjustment rules.
- HCC Risk Adjustment: Identify and code all relevant diagnoses that map to Hierarchical Condition Categories (HCCs) to capture proper patient risk scores.
- Quality & Accuracy Assurance: Perform retrospective or prospective chart audits, maintaining a target accuracy rate (typically 95%–98% or higher).
- Provider Queries & Communication: Identify missing, ambiguous, or incomplete medical record documentation and submit queries to healthcare providers for clarification.
- Compliance & Data Privacy: Strictly adhere to HIPAA regulations, patient privacy standards, and CMS compliance guidelines.
- Reporting: Document findings, audit outcomes, and coding queries using specialized coding software and internal tracking tools.
Pay: ₹15,000.00 - ₹40,000.00 per month
Work Location: In person
