
Principal Medical Coder
7 days ago
A medical coder reviews clinical documentation and assigns appropriate diagnosis and procedure codes using ICD-10-CM, CPT guidelines. This includes conducting Risk Adjustment / HCC coding to identify and code chronic conditions accurately.
The coder performs chart audits to evaluate documentation insufficiencies and ensures they support code assignments. They must ensure coded data adhere to payer / regulatory guidelines and internal compliance standards.
Resolving queries with providers or documentation authors is also a key responsibility when medical records are unclear or missing needed details. Maintaining productivity and accuracy targets while staying updated with coding changes, industry regulations, payer policies, and coding certification requirements is crucial.
The coder participates in ongoing training and process improvement initiatives and assists in denial management, claims adjudication, revenue leakage identification, and support payment integrity.
Maintaining confidentiality and security of patient data is essential.
Required Skills and QualificationsCertification: CPC and/or CRC from recognized bodies.
Educational Qualification: Graduate degree preferably in Life Sciences.
Experience: Typically 1-3 years coding experience in U.S. healthcare / risk adjustment / HCC / multispecialty coding.
Key Skills: Strong knowledge of medical terminology, anatomy & physiology. Proficiency with ICD-10-CM, CPT, HCPCS, and other coding systems.
Personal Attributes: Good analytical skills, attention to detail, ability to work under deadlines. Effective communication skills: both written and verbal.
Technical Skills: Comfortable using EHR/EMR tools, basic MS Office (Excel, Word), coding/auditing software.
Industry Knowledge: Experience with payer policies, Medicare Advantage, Medicaid, RADV audits.
Additional Qualifications: Prior experience in facility setting (inpatient/outpatient) coding, or surgery/pathology specialties. Ability to mentor/train junior coders.
Desirable Attributes: Familiarity with coding compliance, appeals/denials handling.
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