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LSHC - RADV/HCC Coder - Consultant

Deloitte -
Hyderabad, Telangana

Apply Now

Job details

13 days ago

Qualifications

Microsoft Powerpoint
Medicine
Microsoft Excel
EMR systems
Leadership

Full job description

Role Overview

Responsible for Medicare and Accountable Care Act (ACA) Risk Adjustment chart and claim review and analysis to ensure appropriateness and accuracy of ICD-10 coding in relation to risk adjustable coding.

Promotes consistency and accuracy of risk adjustable coding and documentation practices and ensures that clinical services ordered and performed are accurately coded based on documentation and governmental regulations.

Responsible for analyzing coding and documentation. Responsible for retrospective chart and claim coding review. Identifies coding errors and recommends correct coding and terminology usage based on ICD-10-CM in accordance with regulatory agencies and specific guidelines.

Performs ongoing data analysis to identify opportunities to improve, and recapture risk adjustable diagnoses. Identifies and communicate trends to the appropriate teams, including Professional Coding Leadership.

Follows the necessary schedules for team assignments of documentation/coding accuracy. Conducts required, timely Medicare and ACA Risk Adjustment chart reviews and generates summary reports for client. Develops mechanisms to identify specific coding issues related to Medicare and ACA Risk Adjustable coding to allow for follow-up reviews to identify improvement/correction of those elements for which the physician has received education.

Utilizes monitoring tools or other applications to track and report the progress of the Clinician Documentation & Coding Accuracy Plan. Maintains a current understanding of regulatory trends and changes in coding policy and reimbursement that affect the organization by monitoring governmental resources to assess regulatory changes and determine organizational impact.

Maintains up-to-date knowledge of Medicare, ACA, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards. Assist with validation of HCCs as requested by external entities. Conducts Risk Adjustment Validation Audits (RADV) when required by regulatory agencies and participates in quality validation audits from 3rd party vendors/agencies. Assigns appropriate ICD–10-CM codes, mapping to risk adjustment models as applicable.

Identifies and flags encounters when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes. Identifies, evaluates and acts to resolve any barriers to meeting documentation standards. Remains current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirements.

Work you'll do

As a Consultant on the Regulatory Healthcare team, you will be responsible for supporting Medicare and ACA risk adjustment coding reviews, analyzing documentation, and helping clients improve coding accuracy and compliance.

Review medical charts and claims to assess the appropriateness and accuracy of ICD-10-CM coding for risk adjustment.
Perform retrospective coding and documentation reviews to identify errors, gaps, and opportunities to recapture risk-adjustable diagnoses.
Analyze coding and audit results, identify trends, and prepare summary reporting for client and internal stakeholders.
Support RADV activities, HCC validation requests, and other regulatory or quality validation reviews.
Monitor coding policy, reimbursement, and regulatory updates and apply changes to audit, documentation, and coding review activities.

The team

Deloitte provides you an opportunity to gain valuable hands-on experience working alongside leading professionals across diverse industries while building your professional skills in a variety of project experiences. Our Deloitte practice helps organizations effectively navigate business risks and opportunities—from strategic, reputation, and financial risks to operational, cyber, and regulatory risks—to gain competitive advantage. We apply our experience in ongoing business operations and corporate lifecycle events to help clients become stronger and more resilient. Our market-leading team’s help clients embrace complexity to accelerate performance, disrupt through innovation, and lead in their industries.

Location: Hyderabad

Shift Timings: 11 AM to 8 PM or 2 PM to 11 PM IST

Qualifications

Required:

5+ years of experience in HCC coding, risk adjustment coding, or RADV review
Active coding certification from the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC), such as CRC, CCS, CPC, or COC
Experience performing ICD-10-CM coding review and analysis for Medicare and ACA risk adjustment charts and claims
Experience using the Centers for Medicare & Medicaid Services (CMS)-HCC Risk Adjustment Model and CMS coding and documentation guidelines
Experience performing coding audits for inpatient, outpatient, and/or professional claims
Experience using electronic medical record systems and encoder tools such as Epic, 3M, or TruCode
Advanced proficiency in Microsoft Excel and Microsoft PowerPoint

Preferred:

Prior consulting experience
Degree in medicine or an allied healthcare field

Our purpose

Deloitte’s purpose is to make an impact that matters for our people, clients, and communities. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. Our purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities.

Our people and culture

Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ways of thinking, ideas and perspectives, and bring more creativity and innovation to help solve our clients’ most complex challenges. This makes Deloitte one of the most rewarding places to work.

Professional development

At Deloitte, professionals have the opportunity to work with some of the best and discover what works best for them. Here, we prioritize professional growth, offering diverse learning and networking opportunities to help accelerate careers and enhance leadership skills. Our state-of-the-art DU: The Leadership Center in India, located in Hyderabad, represents a tangible symbol of our commitment to the holistic growth and development of our people. Explore DU: The Leadership Center in India.

Benefits to help you thrive

At Deloitte, we know that great people make a great organization. Our comprehensive rewards program helps us deliver a distinctly Deloitte experience that helps that empowers our professionals to thrive mentally, physically, and financially—and live their purpose. To support our professionals and their loved ones, we offer a broad range of benefits. Eligibility requirements may be based on role, tenure, type of employment and/ or other criteria. Learn more about what working at Deloitte can mean for you.

Recruiting tips

From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. Check out recruiting tips from Deloitte recruiters.

Requisition code: 358973

Apply Now

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