Certified Medical Coder

Summary

Certified Medical Coder role is responsible for reviewing, abstracting, and coding inpatient and/or outpatient medical records to ensure proper ICD-10-CM, HCPCS, and CPT coding and compliance with Risk Adjustment requirements.

Key Responsibilities

• Follows CMS Risk Adjustment guidelines and has a complete understanding of their real-world application

• Reviews submitted medical records to identify ICD-10-CM diagnoses, ensuring the documentation meets all CMS standard requirements for valid submission

• Codes all diagnoses and services accurately and completely, from the medical record in accordance with the ICD-10-CM coding classification system

• Selects and accurately records all appropriate records and data on assigned chart abstraction projects

• Ability to meet productivity and accuracy requirements

• Performs other duties as assigned

Qualifications

• High School Diploma or GED required

• A certification in one of the following is required:

• Certified Professional Coder (CPC)

• Certified Risk Adjustment Coder (CRC)

• Certified Coding Specialist (CCS)

• Registered Health Information Technician (RHIT)

• Registered Health Information Administrator (RHIA)

• Minimum of three (3) years HCC experience performing concurrent and retrospective risk adjustment chart reviews required

• Current AAPC or AHIMA credential required

• Risk Adjustment / HCC knowledge required

• Managed Care experience preferred