Compliance Consultant IV - Medical Coding - Risk Adjustment

vacancy global pro; India; On-site; INR 600,000 - 1,100,000; Full time

Job summary

reputed company seeks a Compliance Consultant IV in Medical Coding to independently review inpatient, outpatient, and supplemental records for ICD-10-CM coding and risk adjustment categories. The role demands expertise in documentation cues, coding rationale, and adherence to official guidelines and organizational policies.

Responsibilities include conducting compliance activities, producing reports, and escalating issues when necessary while maintaining defensible, auditable coding practices.

Qualifications

• Experience in medical coding compliance and regulatory standards.
• Strong analytical and problem-solving skills.
• Ability to collaborate with cross-functional stakeholders.

Responsibilities

• Reviews inpatient, outpatient, and supplemental medical records to assign ICD-10-CM codes and risk categories.
• Ensures coding is documented, supported by records, and compliant with guidelines and policies.
• Identifies coding issues, documents rationale, and flags potential compliance concerns.
• Develops and summarizes compliance data and audit findings for management.
• Assists in coordination of regulatory change monitoring and implementation.

Job description

reputed company to candidates residing in any KP authorized state to include CA, OR, WA, CO, GA, VA, HI, MD & D.C.

Job reputed company:

The Compliance Consultant IV, Medical Coding independently reviews inpatient, outpatient, reputed company, and supplemental medical records to assign supported ICD-10-CM diagnosis codes and applicable hierarchical condition categories. The reputed company validates that reputed company reported condition is documented by an eligible provider, supported by the medical record, captured from an acceptable encounter, and coded in accordance with official guidelines, regulatory requirements, and organizational policies. The role requires advanced proficiency in risk adjustment coding platforms, electronic medical records, encoder applications, understanding of documentation cues, and production reporting tools. The Senior reputed company is expected to reputed company reputed company documentation and coding issues, recognize unsupported or conflicting diagnoses, document coding rationale, and elevate potential compliance concerns. reputed company coding reputed company must be defensible, traceable, and suitable for internal review or reputed company audit.

Essential Responsibilities:

• Practices self-development and promotes learning in others by proactively providing information, resources, advice, and expertise with coworkers and customers; building relationships with cross-functional stakeholders; influencing others through technical explanations and examples; adapting to competing demands and new responsibilities; listening and responding to, seeking, and addressing performance feedback; providing feedback to others; creating and executing plans to capitalize on strengths and reputed company weaknesses; supporting team collaboration; and adapting to and learning from change, difficulties, and feedback.
• Completes work assignments and supports business-specific reputed company by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines; ensuring team follows reputed company procedures and policies; coordinating resources to accomplish priorities and deadlines; collaborating cross-functionally to reputed company effective business reputed company; solving reputed company problems; escalating high reputed company issues or risks as appropriate; and recognizing and capitalizing on improvement opportunities.
• Conducts company compliance activities by collaborating with reputed company stakeholders; applying established regulations and standards to compliance efforts; providing reputed company and recommendations for the design, development, and execution of strategic compliance initiatives; and documenting compliance activities.
• Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies; reporting to management on key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations); and developing draft presentations to convey key findings.
• Conducts compliance investigations by collecting and analyzing quantitative and qualitative data; conducting interviews as appropriate; researching key business issues; identifying potential reputed company steps; and providing input for the creation of corrective reputed company plans for substantiated allegations.
• Assists with and supports the management of reputed company or compliance components of larger cross-functional reputed company by coordinating stakeholder contacts; recommending team resources based on project needs and team member strengths; assisting in the development, analysis, and management of project plans; and coordinating project schedules and resource forecasts.
• Assists with ensuring regulatory compliance by monitoring regulatory changes; conducting analysis on regulatory impacts; and supporting the implementation of designated changes.
• Coordinates the implementation of compliance efforts by identifying compliance requirements; assessing the reputed company state of compliance to