We are hiring Medical Coders for Prospective Coding / CDI Reviewer roles with strong knowledge of ICD-10-CM coding, HCC coding, risk adjustment, and clinical documentation review.
Roles and Responsibilities
- Review medical records prospectively for documentation completeness and coding accuracy.
- Identify missing, unclear, conflicting, or incomplete provider documentation.
- Validate diagnoses using clinical evidence and documentation support.
- Identify HCC/risk adjustment opportunities based on documented conditions.
- Review chronic conditions using MEAT/TAMPER documentation principles.
- Identify gaps in specificity, severity, acuity, laterality, and complications.
- Prepare compliant provider queries wherever documentation clarification is required.
- Ensure coding recommendations follow ICD-10-CM guidelines, client instructions, payer policies, and compliance requirements.
- Work closely with coding, audit, CDI, and quality teams.
- Maintain defined productivity and quality standards.
- Participate in feedback sessions, calibration calls, and refresher trainings.
- Follow HIPAA and information security guidelines.
Required Skills:
- Strong knowledge of ICD-10-CM coding guidelines.
- Valuable understanding of CDI concepts and provider documentation requirements.
- Experience in HCC coding / risk adjustment coding.
- Ability to identify documentation gaps and clinical inconsistencies.
- Knowledge of MEAT/TAMPER concepts.
- Good written communication and analytical skills.
- Ability to follow client-specific guidelines and process instructions.