Medical Coder

agilonhealth; Bengaluru; On-site; INR 400,000 - 700,000; Full time

Job summary

agilonhealth is seeking a Medical Coding Specialist to ensure accurate diagnosis coding across services. You will review records for CMS HCC alignment, identify HEDIS exclusions, and apply CPT II codes, using coding software and reference materials.

This role requires strong analytical skills and up-to-date knowledge of coding guidelines. Based in Bengaluru, the position involves system entries, post-query resolutions, and ongoing training to maintain coding quality and compliance with

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

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