Conducts coding and billing compliance reviews on medical records to validate the ICD-10-CM and ICD-10-PCS codes, CPT and HCPCS codes for various specialty (including but not limited to Inpatient, outpatient, professional and Medicare advantage setting). The review of the medical documentation is conducted to identify additional missed provider documentation clarifications and/or missed coding opportunities. The skilled will utilize the following resources to perform the reviews (not inclusive): The Official Coding Guidelines, ICD-10-CM/PCS, CPT and HCPCs coding guidelines, Federal and State regulations, the American Hospital Association (AHA) coding guidelines including the Coding Clinic and American Medical Association’s (AMA) CPT Assistant publications and American Health Information Association (AHIMA) compliant query guidelines.
Work you'll do
As a Consultant or equivalent on the Regulatory Healthcare Practice team, you will be responsible for supporting coding and billing compliance reviews, identifying documentation and coding opportunities,
and helping clients address regulatory and operational challenges.
Perform coding and billing quality reviews for outpatient and qualified encounters to validate diagnosis, procedure, modifier, and payment accuracy.
Review medical documentation to identify missed coding opportunities, missed documentation clarification opportunities, and medical necessity considerations.
Evaluate coder-generated clinical documentation queries for appropriateness and compliance with applicable guidance.
Research coding and billing regulations, payer requirements, and industry standards to support review findings and recommendations.
Prepare written rationales, track assigned work, report findings to stakeholders, and support training, mentoring, and education efforts.
The team
Deloitte’s Risk & Financial Advisory provides you an prospect to gain valuable hands-on experience working alongside leadi