Medical Coder

AI-Risk Coding Associate

• Assigns diagnosis codes according to the Official ICD-10-CM Guidelines for Coding and Reports for conditions which map to the Center for Medicare & Medicaid Services Hierarchical Condition Categories (CMS-HCC) applicable for the year(s) of service being reviewed
• Conducts thorough review of charts by effectively using computer-assisted coding tools to review and interpret medical records, and applies in-depth knowledge of coding principles to assign valid diagnosis codes which are supported by evidence in the medical record on the same date of service
• Demonstrates knowledge of what constitutes a medical record acceptable for supporting CMS-HCCs, including signature guidelines, member identifiers, provider types, medical record encounter/visit types, and places of service
• Demonstrates advanced knowledge of medical terminology, anatomy and physiology as they pertain to assigning appropriate codes and identifying pertinent supporting information in the medical record
• Manages individual quality of work & productivity toward meeting or exceeding targets.
• Performs administrative tasks and work as directed by Team Lead/Operations Lead/Quality Lead.
• Consults Team Lead/Operations Manager and/or Coding SME timely and appropriately.