Medical Coder Job in Clarus RCM Infotech at Hitech City, Hyderabad-Others, Hyderabad

Key Responsibilities

1. Review and Analyze Medical Records

• Review patient medical records, provider notes, and encounter documentation to extract relevant diagnoses.

• Analyze clinical documentation to ensure all reportable conditions are accurately captured and coded.

• Identify HCC-qualifying conditions based on CMS guidelines.

2. Assign Accurate ICD-10-CM Codes

• Assign appropriate ICD-10-CM diagnosis codes to all documented conditions, in accordance with HCC guidelines.

• Apply coding conventions and CMS instructions to ensure the correct mapping of diagnoses to HCC categories.

• Ensure coding is consistent with official coding rules, policies, and payer-specific guidelines.

3. Risk Adjustment Coding

• Perform coding for Medicare Advantage, ACA, and other risk-adjusted populations.

• Ensure that chronic conditions and other relevant diagnoses that affect the risk score are appropriately captured each calendar year.

• Identify and flag suspect or missing codes for provider queries or chart reviews.

4. Provider Communication and Education

• Collaborate with physicians and clinical staff to clarify documentation and improve coding accuracy.

• Provide feedback and education to providers on HCC documentation best practices.

• Assist in creating documentation improvement strategies related to risk adjustment coding.

5. Compliance and Quality Assurance

• Maintain compliance with CMS guidelines, HIPAA regulations, and corporate policies.

• Participate in internal and external audits; provide records and explanations as needed.

• Review audit results and implement feedback or corrective actions to improve coding quality.

6. Reporting and Data Management

• Use coding software and electronic health records (EHR) to review, code, and submit encounters.

• Monitor coding productivity and accuracy benchmarks.

• Maintain accurate logs and coding summaries for reporting and analytics.