Certified MRA Coder I, will perform Retrospective Review to assist healthcare providers in identifying and resolving issues related to incomplete or missing clinical documentation. Increase accuracy, completeness and compliance with clinical condition documentation to enable providers to deliver quality of care.
- Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
- Performs on-site or in-office electronic medical record review to ensure capture of all relevant diagnosis is based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
- MRA coder will conducts audits to abstract data not submitted by providers.
- Reviews medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries
- Focus on retrospective coding to close HCC gaps and add HCC codes not reported.
- Ensure diagnosis codes are supported by the documentation and ensure adherence with ICD-10CM Guidelines for Coding and Reporting.
- Ensure diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.