HCC Risk Adjustment Quality Coding Specialist II
UPMC
Purpose:
Responsible for reviewing medical records for Hierarchical Condition Category (HCC) diagnosis codes for focused claims reviews and government audits. Performs auditing functions including monitoring, and coding of HCC diagnosis codes. Reviews medical record documentation, to ensure the HCC diagnosis code(s) are supported within audit year, utilizing AHA Coding clinics, ICD-10-CM Coding Guidelines, and government regulations. Participates in government audits. Assists with the on boarding, and training of new team members. Provides audit and coding related support to the internal Risk Adjustment Department.
Responsible for reviewing medical records for Hierarchical Condition Category (HCC) diagnosis codes for focused claims reviews and government audits. Performs auditing functions including monitoring, and coding of HCC diagnosis codes. Reviews medical record documentation, to ensure the HCC diagnosis code(s) are supported within audit year, utilizing AHA Coding clinics, ICD-10-CM Coding Guidelines, and government regulations. Participates in government audits. Assists with the on boarding, and training of new team members. Provides audit and coding related support to the internal Risk Adjustment Department.
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