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About the Role

This role involves abstracting and assigning ICD-10-CM diagnosis codes, conducting audits for coding accuracy, and analyzing Medicare Risk Adjustment data to identify patterns and develop interventions.

Responsibilities

• Abstract and assign ICD-10-CM diagnosis codes supported in encounter documentation with minimal oversight.
• Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.
• Perform comprehensive reviews of provider actions within the Value-Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
• Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions.
• Keep leadership informed of project activities through written and oral updates and proactively identify project risks.
• Consistently meet or exceed accuracy and productivity benchmarks.
• May be assigned additional projects or a higher workload volume than a Level I specialist.

Requirements

• Minimum 2 years of coding or related medical experience, including 1 year of HCC coding.
• Advanced knowledge of medical terminology, anatomy, physiology, and disease processes.
• Extensive understanding of ICD-10-CM conventions, documentation standards, and reimbursement systems.
• Strong technical skills, including proficiency with MS Office (Excel, Word, Access, PowerPoint).
• Demonstrated ability to use a variety of electronic medical record systems.
• Ability to manage a significant workload and meet deadlines with minimal supervision.
• Strong organizational, analytical, mathematical, and problem-solving skills.
• Effective written and verbal communication abilities.
• Experience contributing to project work, educational development, or group presentations.

Skills

• ICD-10-CM coding
• HCC coding
• Medical terminology
• Anatomy
• Physiology
• Disease processes
• MS Office (Excel, Word, Access, PowerPoint)
• Electronic medical record systems
• Auditing
• Data analysis
• Project management
• Communication

Experience Level

• Minimum 2 years of coding or related medical experience
• 1 year of HCC coding experience

Salary/Compensations

• $20.90 to $31.35