• The coder will evaluate medical records to verify the plan of care for chronic medical conditions.
• The coder will perform accurate and timely coding review and validation of Hierarchical Condition Categories (HCCs) and Diagnoses through medical records. The coder will document ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment Guidelines.
• The coder will assist the project teams by completing review of all charts in line with Medicare & Medicaid Risk Adjustment criteria.
• Apply understanding of anatomy and physiology to interpret clinical documentation and identify applicable medical codes.
• Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.
• Evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS for reimbursement and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC)conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives
• Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information
• Meet the production targets
• Meet the Quality parameters as defined by the Client SLA
• Other duties as assigned by supervisors.

Role: Medical Biller / Coder

Industry Type: Analytics / KPO / Research

Department: Healthcare & Life Sciences

Employment Type: Full Time, Permanent

Role Category: Health Informatics

Education

UG: Any Graduate

About the company

Optum India is the global capability center of UnitedHealth Group, ranked highly on the Fortune 500 list of United States corporations. We are committed to helping people live healthier lives and helping make the health system work better for everyone. With over two decades of our presence in India, our talented colleagues create value and deliver quality outcomes across the continuum of healthcare. We drive innovation by integrating healthcare operations, advanced data analytics, and technology solutions to enable an improved health system for the consumers we are privileged to serve.