HEDIS Coder/Abstractor

The Medical Coder is responsible for reviewing medical records and coding auditing the services provided.
Primary Responsibilities:

• Reviewing medical records and documents to abstract clinical data for HEDIS reporting
• Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes
• Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules, and guidelines
• Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes
• Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes
• Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information
• Follow up with providers as necessary when responses to queries are not provided in a timely basis
• Utilize medical coding software programs or reference materials to identify appropriate codes
• Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions)
• Assist with ensuring that the medical record collection, review, and abstractions are complete and compliant in accordance with NCQA HEDIS technical specifications and guidelines.
• Apply post-query response to make final determinations.
• Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process
• Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations.
• Leverage relevant computer software programs (e.g., Microsoft Office) to record information, analyze data, or communicate with others
• Utilize and navigate across clinical software applications to assign medical codes or complete reviews

Required Qualifications:

• High school education or equivalent experience
• Active CPC, CRC, RHIT, RHIA Coding Certification (AAPC) or CCS Certification (AHIMA)
• 2+ years of experience supporting HEDIS and/or quality improvement, and medical coding