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Hedis Coder/Abstractor Specialist

1 month ago

Texas City, Texas, United States PSG Global Solutions Careers Full time
Job Title: Hedis Coder/Abstractor

We are seeking a highly skilled Hedis Coder/Abstractor to join our team at PSG Global Solutions Careers. As a Hedis Coder/Abstractor, you will play a critical role in reviewing medical records and documenting clinical data for Hedis reporting.

Key Responsibilities:
  • Review medical records and extract relevant clinical data for Hedis reporting.
  • Identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes.
  • Utilize resources and reference materials to identify appropriate medical codes and reference code applicability, rules, and guidelines.
  • Apply understanding of relevant medical coding subject areas 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.
  • Assist with ensuring that medical record collection, review, and abstractions are complete and compliant 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.
  • Record information, analyze data, or communicate with others.
  • Utilize and navigate across clinical software applications to assign medical codes or complete reviews.
About Our Client:

Our client is a fast-growing industry-recognized staffing firm with 20+ years of experience and growth. We connect top talent with premier organizations in various industries, including IT, Financial, Engineering, Healthcare, and Data Analytics.

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