major roles and responsibilities
review and analyze medical records
examine patient charts and clinical documentation to extract relevant diagnoses and procedures for accurate coding.
assign accurate medical codes
apply correct icd-10-cm, cpt, and hcpcs codes based on the documented clinical information.
ensure coding compliance
ensure that all coding adheres to official coding guidelines, payer policies, and regulatory standards (., cms, hipaa).
conduct coding audits
perform internal and external audits to ensure accuracy, completeness, and compliance of coded data.
support risk adjustment initiatives
identify and assign hcc (hierarchical condition category) codes for risk adjustment purposes, especially in medicare advantage plans.
collaborate with clinical staff
communicate with physicians and healthcare providers to clarify documentation and ensure accurate code assignment.
monitor and resolve denials
analyze coding-related claim denials and rejections, and make necessary corrections for resubmission.
maintain coding productivity and accuracy
meet or exceed established benchmarks for coding speed and accuracy in line with organizational goals.
stay updated with coding guidelines
continuously update knowledge of changes in coding systems, payer rules, and industry regulations.
support revenue cycle management
ensure that proper coding facilitates correct billing, timely reimbursement, and improved financial performance.