Clinical Documentation Specialist

2 weeks ago

Udaipur, Rajasthan, India beBeeMedicalCoder Full time ₹ 9,00,000 - ₹ 12,00,000
Medical Coding Specialist

We are seeking a skilled Medical Coding Specialist to join our team. The successful candidate will be responsible for reviewing clinical documentation, assigning diagnosis and procedure codes, and conducting risk adjustment coding.

  • Coding Review: Review clinical documentation (patient medical records) and assign appropriate diagnosis and procedure codes using ICD‑10‑CM, CPT (and HCPCS if applicable) guidelines.
  • Risk Adjustment Coding: Conduct Risk Adjustment / HCC (Hierarchical Condition Category) coding: identify and code chronic conditions accurately.
  • Chart Audits: Perform chart audits to evaluate documentation insufficiencies and ensure they support code assignments.
  • Coding Compliance: Ensure that coded data adhere to payer / regulatory guidelines and internal compliance standards.
  • Query Resolution: Resolve queries with providers or documentation authors when medical records are unclear or missing needed details.
  • Productivity and Accuracy Targets: Maintain productivity and accuracy targets as set by the team / project (for example, % accuracy, turnaround time).
  • Staying Updated: Stay updated with coding changes, industry regulations, payer policies (e.g. CMS, Medicare Advantage etc.), and coding certification requirements.
  • Ongoing Training: Participate in ongoing training and process improvement initiatives.

Required 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: Strong knowledge of medical terminology, anatomy & physiology.
  • Proficiency: Proficiency with ICD‑10‑CM, CPT, HCPCS (if needed), and other coding systems.
  • Analytical Skills: Good analytical skills, attention to detail, ability to work under deadlines.
  • Communication Skills: Communication skills: both written and verbal (for interacting with providers, auditors, etc.).
  • Computer Skills: Computer skills: comfortable using EHR / EMR tools, basic MS Office (Excel, Word), coding / auditing software.
  • Experience with Payer Policies: Experience with payer policies, Medicare Advantage, Medicaid, RADV audits.
  • Prior Experience: Prior experience in facility setting (inpatient / outpatient) coding, or surgery / pathology etc specialties.
  • Able to Mentor: Ability to mentor / train junior coders.
  • Familiarity with Coding Compliance: Familiarity with coding compliance, appeals / denials handling.

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