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HEDIS Coder/Abstractor Specialist

2 months ago


Selma, Alabama, United States PSG Global Solutions Careers Full time
About the Role

We are seeking a highly skilled HEDIS Coder/Abstractor Specialist to join our team at PSG Global Solutions Careers. As a key member of our team, you will play a critical role in ensuring the accuracy and quality of our medical coding and data abstraction services.

Key Responsibilities
  • Review medical records and document to abstract clinical data for HEDIS reporting, ensuring compliance with NCQA HEDIS technical specifications and guidelines.
  • Identify and extract relevant details and data within clinical documentation, making determinations or identifying 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, including diagnosis, procedural, evaluation and management, and ancillary services.
  • 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, including exclusions, sequencing, and inclusions.
  • Assist with ensuring that the medical record collection, review, and abstractions are complete and compliant.
  • 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 specialize in recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent for premier organizations.

We pride ourselves on building relationships based on mutual interest, resulting in low turnover, long-lasting partnerships, and growth. If you're looking for a company invested in your success, we encourage you to apply.

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).