Bronx, New York30+ days ago
Qualifications: Qualifications:- Strong working knowledge of CMSāHCC risk adjustment model (required for accurate coding and compliance)- Solid understanding of ICDā10āCM coding guidelines- Ability to accurately identify and code chronic conditions requiring annual recapture- Experience reviewing faceātoāface encounters and validating provider documentation- Skilled in retrospective and/or prospective chart reviews- Experience with provider education or documentation improvement initiativesKnowledge, Skills, & Abilities:- Deep understanding of chronic disease processes (e.g., CHF, CKD, COPD, diabetes with complications)- Familiarity with hierarchical logic and exclusion rules in HCC coding- Strong analytical, organizational, and problemāsolving skills, especially in Excel- Ability to research and resolve coding discrepancies independently- Effective written and verbal communication with clinical and nonāclinical staff- Team-based orientation with ability to manage and report out KPIs- Cultural sensitivity and ability to work with diverse team members, both US-based and offshore, and with medical providers- Consistent ability to meet productivity and quality benchmarksEducation:- High School Diploma or equivalent (required)- International Medical Graduate (preferred)- Certified Risk Adjustment Coder (CRC)- Certified Professional Coder (CPC) or CCS / RHIT / RHIA (AAPC or AHIMA)Compensation & Benefits. They will become experts in HCC-based risk adjustment (prior experience preferred, but not necessary), they will conduct medical chart reviews to identify suspect conditions, and they will design and manage workflows to ensure that providers are made aware of suspect conditions, so that they can evaluate the patient thoroughly and correctly document the patientās risk factors.