HCC Coding Validation Specialists

HealthCare Resolution Services•Columbia, MD

5d•Remote

About The Position

We are seeking a highly skilled and detail-oriented HCC Coding Analyst to join our healthcare revenue cycle management team. The ideal candidate will possess a comprehensive understanding of hierarchical condition categories (HCC) coding, medical billing, and medical record abstraction. As an HCC Coding Analyst, you will play a vital role in ensuring accurate documentation and coding of patient records to optimize reimbursement from government programs such as the Centers for Medicare and Medicaid Services (CMS). Your expertise in ICD-9, ICD-10, CPT coding, and DRG assignment will contribute significantly to the efficiency and compliance of our billing processes. This position offers an opportunity to work within a dynamic healthcare environment dedicated to accuracy, compliance, and quality patient care.

Requirements

Proven experience in medical coding with a focus on HCC coding within a healthcare setting.
Strong knowledge of ICD-9, ICD-10, CPT coding systems, and DRG assignment processes.
Familiarity with medical billing procedures, medical records management, and electronic health record (EHR) systems.
Understanding of the CMS guidelines for risk adjustment models and reimbursement policies.
Excellent attention to detail with the ability to accurately abstract information from complex medical records.
Knowledge of medical terminology, anatomy, pathology, and clinical documentation practices.
Prior experience with electronic health records (EHR) management for billing and coding is highly desirable.
Effective communication skills for collaborating with clinicians, billing teams, and auditors.

Responsibilities

Review NLP-generated HCC coding output.
Validate assigned codes against available documentation.
Identify unsupported, inaccurate, or missing codes.
Make corrections in the platform or designated workflow.
Follow customer coding instructions and project guidelines.
Complete assigned records in accordance with agreed production expectations.
Utilize electronic health record (EHR) systems and electronic health records (EHR) management tools for coding, record abstraction, and billing workflows.
Conduct audits of coded records to identify discrepancies and implement corrective actions to improve coding accuracy.
Maintain up-to-date knowledge of changes in medical coding standards, CMS regulations, and healthcare policies affecting reimbursement.
Support revenue cycle management initiatives by ensuring precise coding that maximizes appropriate reimbursements while maintaining compliance.