Healthcare Coding Specialist

1 day ago

Nashik, Maharashtra, India beBeeCoder Full time ₹ 9,00,000 - ₹ 12,50,000

Key Responsibilities:

  • Review patient medical records and assign appropriate diagnosis and procedure codes in accordance with ICD-10-CM, CPT, and HCPCS guidelines.
  • Conduct Risk Adjustment/HCC coding: accurately identify and code chronic conditions for enhanced reimbursement and reduced denial rates.
  • Perform chart audits to evaluate documentation insufficiencies and ensure they support code assignments, thereby maintaining data integrity.
  • Ensure coded data adhere to payer/regulatory guidelines and internal compliance standards, promoting accurate reimbursement and regulatory compliance.
  • Resolve queries with healthcare providers or documentation authors when medical records are unclear or missing needed details, ensuring timely resolution of issues.
  • Maintain productivity and accuracy targets as set by the team/project, driving efficiency and quality improvements.
  • Stay updated with coding changes, industry regulations, and certification requirements to maintain expertise and stay ahead of evolving coding landscapes.
  • Participate in ongoing training and process improvement initiatives, fostering a culture of continuous learning and improvement.
  • Assist in denial management, claims adjudication, revenue leakage identification, and payment integrity efforts, optimizing financial performance and minimizing risk.
  • Maintain confidentiality and security of patient data in accordance with HIPAA/local laws, upholding the highest standards of patient confidentiality and data protection.
Required Skills and Qualifications:
  • Certification: CPC/CRC from recognized bodies (AAPC).
  • Educational Qualification: Graduate degree preferably in Life Sciences.
  • Experience: 1-3 years coding experience in U.S. healthcare/risk adjustment/multispecialty coding.
  • Strong knowledge of medical terminology, anatomy, and physiology.
  • Proficiency with ICD-10-CM, CPT, HCPCS, and other coding systems.
  • Good analytical skills, attention to detail, ability to work under deadlines.
  • Communication skills: written and verbal.
  • Computer skills: EHR/EMR tools, MS Office, coding/auditing software.
  • Experience with payer policies, Medicare Advantage, Medicaid, RADV audits.
  • Prior experience in facility setting coding, or surgery/pathology specialties.
  • Ability to mentor/train junior coders.
  • Familiarity with coding compliance, appeals/denials handling.

 

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