Medical Mutual
Toledo, OH, USA
Job Summary: Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care Act) and MA (Medicare Advantage) with assigning and maintaining diagnoses medical codes. Evaluates requests for adherence to Company policies for the most precise medical codes. Audits vendors for quality assurance of risk adjustment coding for ACA and MA. Responsibilities Conducts initial retrospective chart audit, documents discrepancies, and identifies and suggests accurate coding opportunities based on coding and clinical knowledge. Codes and rechecks all diagnoses and procedures by applying ICD-CM and CPT-4 codes adhering to all official coding guidelines, federal and state regulations, AHA Coding Clinic determinations, health system and departmental policies, internal coding guidelines, and productivity standards. Supports Risk Adjustment Data Validation (RADV) audits required by CMS for ACA and MA Risk Plans. Assists in preparation and...