Job Title: Medical Coder – HCC (Risk Adjustment)

Location- Mumbai

Job Summary:

The HCC Coder is responsible for reviewing and analyzing patient medical records to assign accurate ICD-10-CM diagnosis codes in accordance with CMS-HCC (Hierarchical Condition Category) risk adjustment guidelines. The role focuses on ensuring proper documentation, compliance, and accurate Risk Adjustment Factor (RAF) scoring for reimbursement purposes.

Key Responsibilities:
Medical Coding & Review
Review patient medical records including outpatient, inpatient, and home health documentation.
Assign accurate ICD-10-CM codes based on clinical documentation.
Map diagnosis codes to appropriate HCC categories.
Risk Adjustment (HCC) Coding
Perform coding for risk adjustment projects following CMS guidelines.
Ensure accurate capture of chronic and high-risk conditions impacting RAF scores.
Apply knowledge of disease hierarchy and HCC models.
Documentation Validation
Ensure all coded diagnoses meet MEAT (Monitor, Evaluate, Assess, Treat) criteria.




Identify incomplete or insufficient documentation.
Avoid unsupported, suspected, or rule-out diagnoses.
Quality & Compliance
Adhere to CMS-HCC coding guidelines and ICD-10-CM standards.
Maintain high coding accuracy and quality benchmarks.
Participate in internal and external audits.
Productivity Management
Meet daily coding targets and turnaround time (TAT).
Maintain a balance between productivity and accuracy.
Collaboration
Work closely with QA teams, auditors, and team leads.
Address feedback and improve coding performance.
Continuous Learning
Stay updated with annual ICD-10-CM changes and CMS-HCC model updates.
Participate in training and skill enhancement programs.

Eligibility Criteria:

Education:
Bachelor’s degree in Life Sciences, Nursing, Pharmacy, or related field
Medical coding certification or diploma preferred

Certification:
CPC / CCS / CRC (preferred)

Experience:

📌 Medical Coder Hcc Mumbai
🏢 Pyxidia Techlab
📍 Mumbai