Found Description
The Risk Adjustment HCC Coder is responsible for accurately reviewing and assigning ICD-10-CM diagnosis codes that map to Medicare Advantage and ACA Commercial Risk Adjustment models. The role ensures compliance with coding guidelines, documentation standards, quality metrics, and productivity requirements while supporting accurate risk adjustment reimbursement.
Key Responsibilities:
- Assign appropriate ICD-10-CM diagnosis codes for Medicare Advantage and ACA Commercial Risk Adjustment projects.
- Review medical records and accurately map diagnoses to applicable Risk Adjustment/HCC models.
- Identify and assign flag events and Clinical Documentation Improvement (CDI) opportunities for documentation discrepancies.
- Adhere to the Standards of Ethical Coding established by the American Health Information Management Association (AHIMA).
- Follow official ICD-10-CM coding guidelines and regulatory requ...