Job Description

Profile Description The role requires: Retrieval and review of documentation in medical records from various client EMR systems. Verify the completeness of the documentation and coding in accordance with the coding compliance guidelines. *Verify the assigned diagnoses, procedural codes, modifiers and HCPCS codes adhering to the general, payer and client specifications (in all forms of audits (prospective, retrospective, focused). Identify errors related to compliance and coding including (provider/DOS/CPT/Mod/ICD) in alignment of the general coding guidelines, client and payer specifications as needed. Identify documentation issues which can be provided to client for documentation improvement Provide written and verbal feedback to the coders on the errors identified Provide daily audit reports and scores to the team members. Conduct huddle meetings on the identified errors if there is a demand, should participate in coding related discussions with client Should be strong in providing references and guidelines when suggesting their response either to coders or to client Key Responsibilities Process: *Retrieve the correct medical record of a patient, review validate completeness of documentation along with signatures, orders for diagnostic tests etc. Review and validate and/or modify, providers, Dates of service, CPT codes, Diagnoses and modifiers by following general coding guidelines, payer specifications and client specifications if any. *Adhere to the standard operating procedures and instructions related to the process in coding. Communicate if there are documentation deficiencies or any other issues which prevent compliant coding. Be focused on self learning and update his/herself with the latest updates of the coding industry. Keep their coding credentials active by submitting their CEUs and renewing their credentials. People: Be a good team player and display respect for each and everyone. Adhere to the organization policies and be a good citizen of IKS. Client: Be customer centric in all aspects of work and meet the production and quality targets on a daily basis. *Be flexible to support client deliverables as needed. Financial: Meet their defined production and quality targets daily. Qualifications Minimum Education Qualification--Graduates in any of the below disciplines: Medical Graduates--MBBS, BHMS, BAMS, BUMS, BDS Paramedical graduates--BPT, B.Pharmacy, B.Sc Nursing, B.Sc Lab/Radiology or any other technicians Life sciences graduates--B.Sc (Biotechnology, chemistry, zoology, Botany, Microbiology, Genetics, etc) Mandatory active coding certification such as CPC, COC, CCS-P. Speciality medical coding auditor credentials if any are preferred such as CPMA Role Prerequisites Minimum graduation in any of the above mentioned disciplines Should hold an active coding certification. Hands-on- coding experience 30 + months in one or more coding lines of business such as Ancillary coding, EM, Surgery, Denials, IP DRG. Functional Competencies (knowledge and skill required. Highlight the MUST HAVES) Must have strong: Anatomy and Medical terminology Pathophysiology *Knowledgeable about diagnoses, procedures, Modifiers and /HCPCS codes and the coding guidelines Basic coding compliance guidelines. Behavioral Competencies Must have strong: Verbal and written communication skills Analytical skills Achievement orientation Integrity Research oriented