Medical Coder

agilon health

Location

India_Bangalore

Key Responsibilities

• Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered.
• Review medical record information to identify all appropriate coding based on CMS HCC model.
• Review medical record information to identify all appropriate HEDIS exclusion codes that do not map in the CMS HCC model.
• Review medical record information to identify all appropriate CPT II procedure coding.
• Utilize medical coding software programs or reference materials to identify appropriate codes.
• Complete appropriate system entry regarding claim/encounter information.
• Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable clinical codes.
• Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
• Maintain a comprehensive tracking and management tool to track all HCC activities and ensure that all tasks are completed in a timely manner.
• Performs AHIMA/ACDIS compliant queries to providers when necessary.
• Apply post-query response to make final determination.
• Participate in ongoing training and education within assigned timeframe.
• Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Communicates to leadership issues and barriers to completing all work processes.
• Educate and mentor others to improve medical coding quality.
• May participate in special project auditing as required.
• All other duties as assigned by leadership.