Medical Coder

agilon health; Bengaluru; On-site; INR 450,000 - 650,000; Full time

Job summary

AHIPL Agilon Health India Private Limited in Bengaluru is seeking a Medical Coder to ensure accurate diagnosis coding, CMS HCC mapping, and CPT II procedure coding. You will review clinical records, apply coding guidelines, and enter claim information to support compliant reimbursements.

You will collaborate with providers, perform post-query follow-ups, and stay updated on coding changes while mentoring teammates to improve coding quality and accuracy.

Qualifications

• Experience in medical coding and clinical documentation review.
• Familiarity with CMS HCC model and coding guidelines.
• Knowledge of CPT/CPT II and HEDIS where applicable.

Responsibilities

• Verify and ensure the accuracy of diagnosis codes based on services rendered.
• Review medical records to identify CMS HCC mappings and exclusions.
• Review records to identify CPT II procedure codes.
• Enter claim/encounter information in the system.
• Apply anatomy and physiology knowledge to interpret documentation.
• Maintain tracking tools for HCC activities and deadlines.
• Perform AHIMA/ACDIS compliant queries to providers when needed.
• Educate and mentor peers to improve coding quality.

Job description

Company: AHIPL Agilon Health India Private Limited

Job Posting Location: India_Bangalore

Job Title: Medical Coder

Job Description:

Primary responsibilities:

• Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered.
• Review medical record information to identify all appropriate coding based on CMS HCC model.
• Review medical record information to identify all appropriate HEDIS exclusion codes that do not map in the CMS HCC model.
• Review medical record information to identify all appropriate CPT II procedure coding
• Utilize medical coding software programs or reference materials to identify appropriate codes
• Complete appropriate system entry regarding claim/encounter information.
• Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable clinical codes
• Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
• Maintain a comprehensive tracking and management tool to track all HCC activities and ensure that all tasks are completed in a timely manner.
• Performs AHIMA/ACDIS compliant queries to providers when necessary
• Apply post-query response to make final determination
• Participate in ongoing training and education within assigned timeframe
• Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations
• Communicates to leadership issues and barriers to completing all work processesEducate and mentor others to improve medical coding quality

May participate in special project auditing as required

• All other duties as assigned by leadership

Location: India_Bangalore