Job Description: HCC Coder
Job Title: Medical Coder HCC (Risk Adjustment)
Location- Mumbai
Job Summary:
The HCC Coder is responsible for reviewing and analyzing patient medical records to assign accurate ICD-10-CM diagnosis codes in accordance with CMS-HCC (Hierarchical Condition Category) risk adjustment guidelines. The role focuses on ensuring proper documentation, compliance, and accurate Risk Adjustment Factor (RAF) scoring for reimbursement purposes.
Key Responsibilities:
1. Medical Coding & Review
- Review patient medical records including outpatient, inpatient, and home health documentation.
- Assign accurate ICD-10-CM codes based on clinical documentation.
- Map diagnosis codes to appropriate HCC categories.
2. Risk Adjustment (HCC) Coding
- Perform coding for risk adjustment projects following CMS guidelines.
- Ensure accurate capture of chronic and high-risk conditions impacting RAF scores.
- Apply knowledge of disease hierarchy and HCC models.
3. Documentation Validation
- Ensure all coded diagnoses meet MEAT (Monitor, Evaluate, Assess, Treat) criteria.
- Identify incomplete or insufficient documentation.
- Avoid unsupported, suspected, or rule-out diagnoses.
4. Quality & Compliance
- Adhere to CMS-HCC coding guidelines and ICD-10-CM standards.
- Maintain high coding accuracy and quality benchmarks.
- Participate in internal and external audits.
5. Productivity Management
- Meet daily coding targets and turnaround time (TAT).
- Maintain a balance between productivity and accuracy.
6. Collaboration
- Work closely with QA teams, auditors, and team leads.
- Address feedback and improve coding performance.
7. Continuous Learning
- Stay updated with annual ICD-10-CM changes and CMS-HCC model updates.
- Participate in training and skill enhancement programs.
Eligibility Criteria:
Education:
- Bachelor's degree in Life Sciences, Nursing, Pharmacy, or related field
- Medical coding certification or diploma preferred
Certification:
- CPC / CCS / CRC (preferred)
Experience:
- Minimum 12 years of experience in medical coding
- Prior experience in HCC or risk adjustment coding preferred
Required Skills:
- Strong knowledge of ICD-10-CM coding guidelines
- Understanding of HCC, RAF, and CMS regulations
- Good knowledge of medical terminology and anatomy
- Ability to analyze and interpret clinical documentation
- High attention to detail and accuracy
- Good communication and teamwork skills
Work Environment:
- Work mode: Office-based
- Industry: US Healthcare (RCM & Risk Adjustment)
- Performance-driven and quality-focused environment
Key Performance Indicators (KPIs):
- Coding accuracy
- Productivity (charts per day)
- Compliance adherence
- Audit scores
