Medical Coding Specialist

Medical Coding Specialist Overview The Medical Coding Specialist will ensure accurate risk adjustment coding for Medicare plans. Collaborate with healthcare providers to address documentation gaps and enhance coding accuracy. Conduct audits and quality control checks on coding outputs for compliance with HCC/ICD-10-CM guidelines. Serve as a senior-level resource, providing second-level reviews and addressing complex coding issues. Educate providers on documentation practices to support accurate risk adjustment coding. Track error patterns and trends in coding quality, reporting findings to improve processes. Work independently to ensure compliance with CMS risk adjustment guidelines and RAF methodology. Support the organization’s mission to provide exceptional care to members through accurate coding practices. Medical Coding Specialist Key Responsibilities & Duties Audit coding team outputs for accuracy and compliance with HCC/ICD-10-CM guidelines. Review disposition decisions and follow up on provider queries for ambiguous documentation. Educate providers on documentation practices supporting risk adjustment coding accuracy. Serve as the escalation point for complex charts and coding questions from the team. Track coding error patterns and trends, reporting findings to improve quality. Develop processes for right-coding, appropriate utilization, and closing gaps in care. Collaborate with physician groups to address areas of over or under utilization. Ensure compliance with CMS risk adjustment guidelines and RAF methodology. Medical Coding Specialist Job Requirements Associate of Applied Science (AAS) degree required. CRC certification mandatory; dual-eligible or FIDE-SNP experience preferred. Minimum of 2 years of experience; 4 years preferred in Managed Care/Medicare Advantage. Strong knowledge of HCC hierarchy, RAF methodology, and CMS risk adjustment guidelines. Ability to read and interpret documents, identifying coding gaps effectively. Proficiency in educating providers on documentation practices for accurate coding. Experience in developing processes for right-coding and closing care gaps. Comfortable working independently and owning second-level review responsibilities. #J-18808-Ljbffr