6 hcc coder jobs found

Job Description Job Description Description: This is a flexible CMS HCC/Risk Validation Audit role for a seasonal project. Other opportunities for continued work may be available at the conclusion of the project. Full time opportunities are available at either 30 or 40 hours weekly. Flexible work hours - nights and weekends are acceptable. Coders will review member and claim data validation aspects, which include: Member name, Member DOB, Gender, Dates of service, claim type, and provider signature Coders will be presented with all risk-adjusting diagnoses billed on a claim for a particular date of service or inpatient stay Must be able to identify acceptable provider specialty Coder must have knowledge of ICD-10-CM IP and OP coding Coders will confirm or not confirm each diagnosis Coders will add risk-adjusting diagnoses that are valid but not reported Requirements: Active certification through AAPC or AHIMA is required Minimum 5 years verifiable risk...

Become a part of our caring community The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Essential Functions You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines...

Become a part of our caring community The Risk Adjustment Coder conducts quality assurance coding of medical records and ICD-10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Coder assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record. Reviewsmedical records toreport conditions that map toHCCs by reviewing medical record documentation and applying theappropriate ICD-10diagnosis codes. Followsstate and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. Works onprojects that may include making phone calls to providers. Works within broad guidelines with little oversight. Demonstratesa...

Become a part of our caring community The Senior Market Consultation / Partnership Professional (Nurse Medical Coder) supports Clinical Support Team (CST) initiatives by promoting accurate, compliant, and complete documentation and coding practices that enhance the quality and measurement of programs across risk adjustment. Work assignments involve moderately complex to complex issues where analysis of clinical documentation, coding accuracy, and risk adjustment data requires evaluation of multiple variable factors. Key Responsibilities Perform detailed medical record reviews to ensure accurate ICD-10-CM coding, risk adjustment capture, and alignment with CMS-HCC (e.g., V24/V28) models Validate diagnosis coding and ensure documentation meets compliance standards Identify and escalate coding trends and documentation gaps Serve as a coding subject matter expert supporting CST workflows, including PDV, chart review prioritization, and provider outreach...

The Single Pathway Cardiology Cath Lab/Interventional Radiology (IVR) Coder i s responsible for accurately assigning professional and facility codes for diagnostic and interventional cardiology and radiology procedures from a single medical record review. This role ensures complete and compliant code assignment, appropriate charge capture, and adherence to all federal, state, payer, and organizational coding guidelines. The coder serves as a subject matter expert for complex procedural coding. Roles & Responsibilities Review medical records and supporting documentation for outpatient and inpatient Cath Lab and IVR encounters. Assign accurate ICD-10-CM diagnosis codes, CPT/HCPCS procedure codes, modifiers, and applicable revenue codes for both facility and professional billing pathways. Abstract and validate procedural details, including diagnostic cardiac catheterizations, percutaneous coronary interventions (PCI), electrophysiology procedures, peripheral...

Assign ICD-10-CM codes, CPT and HCPC codes for inpatient, ED, Ambulatory Surgery, and other outpatient records. Assign appropriate DRG or APC based on review of the admission diagnoses, principal diagnoses and other operations and procedures. Assign ICD-10-CM, CPT4 and HCPC codes as appropriate based on documentation from the report, order or medical record following coding rules and guidelines. Ensure that outpatient ICD-10 codes are entered onto the computer within the timeframe allotted to assure accurate billing. Requirements: High School diploma required. Minimum one year ICD-10-CM/CPT4 coding experience in hospital or related setting. Knowledge of CRT/PC and other technology as well as knowledge of APC categories required. Knowledge of medical terminology, anatomy and physiology.