We are hiring Medical Coders for Prospective Coding / CDI Reviewer roles with solid 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.