Identify, create and provide education to internal/external partners on: Examples of clinical documentation and coding that do not comply with federal, state and/or county regulations/laws related to risk adjustment coding and documentation guidelines Examples of missed clinical documentation and coding improvement opportunities for both quality and risk adjustment measures and targets Examples of clinical coding and documentation trends and training needs to improve the accuracy and quality of documentation and coding overall. Review clinical documentation to identifying opportunities for improving risk adjustment score accuracy via clinical documentation and coding assignments. Create compliant provider queries for any diagnosis/procedure codes unsubstantiated by the clinical documentation.

Coding: Assign appropriate ICD-10-CM, CPT and HCPCS codes per the various risk adjustment models (HHS/HCC, CMS/HCC and Rx/HCC) for the all lines of business (MediCare, Commercial and MediCal/MediCaid) and in accordance with federal, state, county regulations/laws and standard coding guidelines (CMS, Coding Clinic and CPT Assistant).

Certified risk adjustment coder