This position reviews and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters covering a wide variety of clinical cases and services for risk adjustment models. This position is responsible for translating diagnostic phrases utilized by healthcare providers into coded form. The incumbent must have the skill sets to: * Select correct ICD code assignment by proficient analysis and translation of diagnostic statements, physicians' orders, and other pertinent documentation. * Critically evaluate valid encounters, including face-to-face, legibility and valid signature, per Medicare, Commercial and Federal and State requirements * Maintain and grow the current knowledge of the Medicare and Commercial Risk Adjustment outpatient/inpatient billing systems/processes * Facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness * Stay current on all changes in coding conventions and coding updates * Conduct prospective and retrospective member reviews to close care gaps * Adhere to the coding guidelines * Work both in a team and individual environment with minimum supervision and is confident working with a wide variety of healthcare professionals * Consistently meet or exceed productivity and quality standards The Incumbent must have a thorough understanding of the content of the medical record in order to be able to locate information to support or provide specificity for coding. The coder must be trained in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded. This position does not provide patient care.
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