Role Overview

Position Summary

Responsible for Medicare and Accountable Care Act (ACA) Risk Adjustment chart and claim review and analysis to ensure appropriateness and accuracy of ICD-10 coding in relation to risk adjustable coding.

Promotes consistency and accuracy of risk adjustable coding and documentation practices and ensures that clinical services ordered and performed are accurately coded based on documentation and governmental regulations.

Responsible for analyzing coding and documentation. Responsible for retrospective chart and claim coding review. Identifies coding errors and recommends correct coding and terminology usage based on ICD-10-CM in accordance with regulatory agencies and specific guidelines.

Performs ongoing data analysis to identify prospects to improve, and recapture risk adjustable diagnoses. Identifies and communicate trends to the appropriate teams, including Qualified Coding Leadership.

Follows the necessary schedules for team assignments of documentation/coding accuracy. Conducts required,



timely Medicare and ACA Risk Adjustment chart reviews and generates summary reports for client. Develops mechanisms to identify specific coding issues related to Medicare and ACA Risk Adjustable coding to allow for follow-up reviews to identify improvement/correction of those elements for which the physician has received education.

Utilizes monitoring tools or other applications to track and report the progress of the Clinician Documentation & Coding Accuracy Plan. Maintains a current understanding of regulatory trends and changes in coding policy and reimbursement that affect the organization by monitoring governmental resources to assess regulatory changes and determine organizational impact.

Maintains up-to-date knowledge of Medicare, ACA, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards. Assist with validation of HCCs as requested by external entities. Conducts Risk Adjustm

📌 Lshc Radv/hcc Coder Hyderabad (India)
🏢 Deloitte
📍 India