Certified Medical Coder

Summary

Certified Medical Coder role is responsible for reviewing, abstracting, and coding inpatient and/or outpatient medical records to ensure proper ICD-10-CM, HCPCS, and CPT coding and compliance with Risk Adjustment requirements.

Key Responsibilities

• Follows CMS Risk Adjustment guidelines and has a complete understanding of their real-world application
• Reviews submitted medical records to identify ICD-10-CM diagnoses, ensuring the documentation meets all CMS standard requirements for valid submission
• Codes all diagnoses and services accurately and completely, from the medical record in accordance with the ICD-10-CM coding classification system
• Selects and accurately records all appropriate records and data on assigned chart abstraction projects
• Ability to meet productivity and accuracy requirements
• Performs other duties as assigned

Qualifications

• High School Diploma or GED required
• A certification in one of the following is required:
• Certified Professional Coder (CPC)
• Certified Risk Adjustment Coder (CRC)
• Certified Coding Specialist (CCS)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)
• Minimum of three (3) years HCC experience performing concurrent and retrospective risk adjustment chart reviews required
• Current AAPC or AHIMA credential required
• Risk Adjustment / HCC knowledge required
• Managed Care experience preferred