Job Title : HCC Medical Coder (Risk Adjustment Coder)
Department: Medical Coding / Revenue Cycle Management (RCM)
Location : Hyderabad
Job Summary
We are seeking a detail-oriented and experienced HCC Medical Coder to review medical records and accurately assign ICD-10-CM diagnosis codes in accordance with CMS-HCC Risk Adjustment guidelines. The ideal candidate will ensure accurate Hierarchical Condition Category (HCC) capture, maintain coding compliance, and contribute to improved quality reporting and reimbursement.
Key Responsibilities
* Review patient medical records, physician documentation, and clinical notes.
* Assign accurate ICD-10-CM diagnosis codes based on current coding guidelines.
* Identify and capture Hierarchical Condition Categories (HCCs) for Medicare Risk Adjustment.
* Ensure documentation supports all assigned diagnosis codes.
* Follow CMS Risk Adjustment, Official ICD-10-CM Coding Guidelines, and client-specific coding policies.
* Query providers for clarification when documentation is incomplete or ambiguous.
* Maintain coding quality and productivity targets established by the organization.
* Participate in internal and external coding audits.
* Stay updated with annual ICD-10-CM, CMS-HCC, and regulatory changes.
* Maintain HIPAA compliance and patient confidentiality.
* Collaborate with Quality Assurance, Clinical Documentation Improvement (CDI), and Operations teams to improve coding accuracy.
Required Qualifications
* Bachelor's degree in Life Sciences, Pharmacy, Nursing, Allied Health, or related healthcare discipline.
* CPC, CRC, CCS, or equivalent coding certification preferred.
* 2+ years of HCC/Risk Adjustment coding experience
* Robust knowledge of ICD-10-CM coding guidelines.
* Good understanding of Medicare Risk Adjustment and CMS-HCC models.
* Familiarity with medical terminology, anatomy, physiology, and disease processes.