
Healthcare Medical Coding Specialist
2 weeks ago
Medical Coding Expertise
">- Utilize clinical documentation to assign accurate diagnosis and procedure codes adhering to ICD-10-CM, CPT, and HCPCS guidelines.
- Perform Risk Adjustment/HCC coding to accurately identify and code chronic conditions.
- Audit charts to evaluate documentation deficiencies ensuring they support code assignments.
- Maintain compliance with payer and regulatory requirements, as well as internal standards.
- Resolve queries with providers or documentation authors when medical records are unclear or missing required details.
- Meet productivity and accuracy targets set by the team/project.
- Stay updated with coding changes, industry regulations, payer policies, and certification requirements.
- Participate in ongoing training and process improvement initiatives.
- Assist in denial management, claims adjudication, revenue leakage identification, and payment integrity.
- Ensure confidentiality and security of patient data (HIPAA/local laws).
Essential Qualifications
">- Certification: CPC and/or CRC from recognized bodies.
- Graduate degree in Life Sciences (e.g., B.Sc, B.Pharma, Biotechnology, Microbiology, Nursing).
- 1-3 years' experience in U.S. healthcare/risk adjustment/multispecialty coding.
- Strong knowledge of medical terminology, anatomy, and physiology.
- Proficiency in ICD-10-CM, CPT, HCPCS, and other coding systems.
- Excellent analytical skills, attention to detail, ability to work under deadlines.
- Effective communication skills for interacting with providers, auditors, etc.
- Computer skills: EHR/EMR tools, basic MS Office (Excel, Word), coding/auditing software.
- Experience with payer policies, Medicare Advantage, Medicaid, RADV audits.
- Facility setting (inpatient/outpatient) coding, or surgery/pathology specialties experience.
- Able to mentor/train junior coders.
- Familiarity with coding compliance, appeals/denials handling.
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