Medical Coder HCC

Job Title: Medical Coder – HCC (Risk Adjustment)

Location- Mumbai

Job Summary:

The HCC Coder is responsible for reviewing and analyzing patient medical records to assign accurate ICD-10-CM diagnosis codes in accordance with CMS-HCC (Hierarchical Condition Category) risk adjustment guidelines. The role focuses on ensuring proper documentation, compliance, and accurate Risk Adjustment Factor (RAF) scoring for reimbursement purposes.

Key Responsibilities:

1. Medical Coding & Review

• Review patient medical records including outpatient, inpatient, and home health documentation.


• Assign accurate ICD-10-CM codes based on clinical documentation.


• Map diagnosis codes to appropriate HCC categories.

2. Risk Adjustment (HCC) Coding

• Perform coding for risk adjustment projects following CMS guidelines.


• Ensure accurate capture of chronic and high-risk conditions impacting RAF scores.


• Apply knowledge of disease hierarchy and HCC models.

3. Documentation Validation

• Ensure all coded diagnoses meet MEAT (Monitor, Evaluate, Assess, Treat) criteria.


• Identify incomplete or insufficient documentation.


• Avoid unsupported, suspected, or rule-out diagnoses.

4. Quality & Compliance

• Adhere to CMS-HCC coding guidelines and ICD-10-CM standards.


• Maintain high coding accuracy and quality benchmarks.


• Participate in internal and external audits.

5. Productivity Management

• Meet daily coding targets and turnaround time (TAT).


• Maintain a balance between productivity and accuracy.

6. Collaboration

• Work closely with QA teams, auditors, and team leads.


• Address feedback and improve coding performance.

7. Continuous Learning

• Stay updated with annual ICD-10-CM changes and CMS-HCC model updates.


• Participate in training and skill enhancement programs.

Eligibility Criteria:

Education:

• Bachelor’s degree in Life Sciences, Nursing, Pharmacy, or related field


• Medical coding certification or diploma preferred

Certification:

• CPC / CCS / CRC (preferred)

Experience:

• Minimum 1–2 years of experience in medical coding


• Prior experience in HCC or risk adjustment coding preferred

Required Skills:

• Strong knowledge of ICD-10-CM coding guidelines


• Understanding of HCC, RAF, and CMS regulations


• Good knowledge of medical terminology and anatomy


• Ability to analyze and interpret clinical documentation


• High attention to detail and accuracy


• Good communication and teamwork skills

Work Environment:

• Work mode: Office-based


• Industry: US Healthcare (RCM & Risk Adjustment)


• Performance-driven and quality-focused environment

Key Performance Indicators (KPIs):

• Coding accuracy


• Productivity (charts per day)


• Compliance adherence


• Audit scores