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