HCC Medical Coder

OverviewGuidehouse is a leading management consulting firm serving the public and commercial markets.

We guide our clients forward towards new futures that build trust in society and your professional skills along the journey.

Join us at Guidehouse.ResponsibilitiesThe HCC Medical Coder ensures the data integrity of coded patient records by reviewing the submitted medical documentation and validating that it accurately supports the assigned codes while following the Official Guidelines for Coding and Reporting, AHA coding clinics, CMS/MAC program guidance, internal policies and procedures and in accordance with all state and federal regulations.Thw HCC Medical coder will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate HCC related ICD-10 Diagnosis codes.

HCC coder will have the ability to identify encounter level discrepancies and documentation improvement opportunities for provider education, as well as identifying and communicating trending issues.

Coder will query providers regarding missing, unclear or conflicting documentation utilizing designated query process.Must have a working knowledge of CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research and regulatory compliance.

Under the direction of the coding manager-the coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets.

*At times, the coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines.Qualifications+ 3 years ICD-10 and CPT Coding Experience+ 2+ years HCC Risk Adjustment Coding experience+ Must have CPC Certification+ Experience working Physician Coding Related Denials, as applicable+ HEDIS abstraction knowledge and experience preferredAdditional RequirementsMental/Physical Requirements:+ Computer Literacy+ Proficiency and Understanding of CMS HCC Risk Adjustment Coding and data validation requirements.+ Understanding of HHS Risk Adjustment Model+ Good working knowledge of Anatomy and Physiology as well as Medical Terminology+ Advanced knowledge of CMS/MAC guidance, Coding Skills, ICD-10-CM and CPT+ Ability to analyze Provider documentation and assign codes accurately+ Excellent verbal and written Communication Skills+ Strong knowledge and application of Government and other payer guidelines as they relate to compliant coding.+ High level of Accuracy and Productivity.

Meets or exceeds standards consistently+ Ability to work independently+ HIPAA compliant work stations+ Strong working knowledge of Protected Health Information+ Maintains professional credentials at all times+ Organizational Skills+ Knowledge of Microsoft Word and ExcelThe successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

DisclaimerAbout GuidehouseGuidehouse is an Equal Employment Opportunity / Affirmative Action employer.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com.

All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies.

All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.Rewards and BenefitsGuidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.#cb