Medical Coding Specialist

1 day ago

Shimoga, Karnataka, India beBeecoder Full time ₹ 6,00,000 - ₹ 12,00,000
Medical Coding Specialist

We are seeking a highly skilled Medical Coding Specialist to join our team. In this role, you will be responsible for reviewing clinical documentation and assigning appropriate diagnosis and procedure codes using ICD-10-CM, CPT, and HCPCS guidelines.

This involves conducting risk adjustment/HCC coding, chart audits, and ensuring compliance with payer and regulatory guidelines. As a Medical Coding Specialist, you will play a critical role in maintaining the accuracy and integrity of our coding data.

Key Responsibilities:

  • Review patient medical records to assign accurate diagnosis and procedure codes
  • Conduct risk adjustment/HCC coding to identify and code chronic conditions accurately
  • Perform chart audits to evaluate documentation insufficiencies and ensure they support code assignments
  • Ensure coded data adhere to payer/regulatory guidelines and internal compliance standards
  • Resolve queries with providers or documentation authors when medical records are unclear or missing needed details
  • Maintain productivity and accuracy targets as set by the team/project
  • Stay updated with coding changes, industry regulations, payer policies, and coding certification requirements
  • Participate in ongoing training and process improvement initiatives
  • Assist in denial management, claims adjudication, revenue leakage identification, and support payment integrity (if applicable)
  • Maintain confidentiality and security of patient data (HIPAA/local laws)

Required Skills and Qualifications:

  • Certification: CPC (Certified Professional Coder) and/or CRC (Certified Risk Adjustment Coder) from recognized bodies (e.g., AAPC)
  • Educational Qualification: Graduate (Bachelor's degree) preferably in Life Sciences (e.g., B.Sc, B.Pharma, Biotechnology, Microbiology, Nursing, etc.)
  • Experience: Typically 1-3 years coding experience in U.S. healthcare/risk adjustment/HCC/multispecialty coding. For senior roles, maybe more.
  • Strong knowledge of medical terminology, anatomy, and physiology
  • Proficiency with ICD-10-CM, CPT, HCPCS (if needed), and other coding systems
  • Good analytical skills, attention to detail, ability to work under deadlines
  • Communication skills: both written and verbal (for interacting with providers, auditors, etc.)
  • Computer skills: comfortable using EHR/EMR tools, basic MS Office (Excel, Word), coding/auditing software
  • Experience with payer policies, Medicare Advantage, Medicaid, RADV audits
  • Prior experience in facility setting (inpatient/outpatient) coding, or surgery/pathology specialties
  • Ability to mentor/train junior coders
  • Familiarity with coding compliance, appeals/denials handling

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