· Validate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records
· Review and identify trends in coding discrepancies and notify applicable department for potential training and education
· Determine coding issues and discrepancies and make updates as necessary
· Identify issues, determine impact to risk adjustment models and reports results for various products and services
· Coordinate delete files with leadership from Medicaid, Medicare, and Marketplace and Encounters department
· High school diploma or equivalent and 2+ years of medical coding.
· Risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry OR Associate’s degree in health-related field and 1+ years of medical coding.
· Risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry.
· Experience with various risk adjustment methodology and chart audits.
· CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA or CPMA required.