The HCC Professional Coder is responsible for: 

· Review clinical documentation and assign accurate diagnosis codes according to CMS guidelines 

· Verify the appropriateness of the ICD-10 code to include required supporting documentation and treatment plans 

· Review medical documents such as progress notes, surgical reports, medical visits and diagnosis report in order to create educational strategies to ensure correct diagnosis code assignment by the provider 

· Review medical records and billing history to determine if specific disease conditions were correctly billed and documented. 

· Document detailed chart audit findings including all coding and documentation errors as well as any potential HCC opportunities. 

· Improve coding accuracy by performing independent audits of physician records. 

· Assist in developing strategic initiatives and training material tools related to HCC score improvement and accuracy for physician group 

· Provide training to provider groups related to HCC documentation and coding 

· Serves as a subject matter expert on MRA coding 

· Perform other assigned duties/special projects on an as-needed basis. 

Requirements, Skills and Abilities: 

· Requires knowledge in Medicare Risk Adjustment (MRA) HCC coding documentation guidelines, rules and regulations 

· Requires technical expertise in ICD-10-CM 

· Prefer 2 years of HCC coding experience or Medical Assitant expereince 

· Can appropriately use coding principles to code to the highest specificity 

· Proven success in building relationships and establishing credibility with providers and other clinical staff 

· Strong skills in medical record audit and review 

· Understanding of healthcare data systems 

· Strong proficiency with MS word and Excel 

· Excellent problem-solving abilities along with written and verbal communication skills 

· Strong collaboration and relationship building skills/Strong Team Player 

· Ability to travel (day trips) 

Minimum Education: A High School Diploma or Equivalent