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Associate II - BPM

Associate II - BPM

UST

2 years

0 Lacs

kochi kerala india

Posted:2 days ago| Platform:

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Skills Required

risk capture support documentation compliance regulations coding auditing data metrics certification certifications membership maintenance healthcare pharmacology physiology pathology management efficiency communication

Work Mode

Remote

Job Type

Full Time

Job Description

Role Description

The Certified MRA Coder I performs

retrospective reviews

of medical records to abstract

ICD-10-CM diagnosis codes

in alignment with

Risk Adjustment program

requirements. The goal is to accurately capture the health plan members’ burden of illness and support proper documentation for

Commercial, Medicare, and Medicaid

Risk Adjustment Programs.

Primary Responsibilities

Ensure compliance with all applicable federal laws and regulations related to coding and documentation for Risk Adjustment Programs.
Conduct remote medical record reviews to identify and capture relevant diagnosis codes that fall under Hierarchical Condition Categories (HCC).
Perform two-way reviews by auditing claims data and removing unsupported ICD-10-CM codes.
Validate that all diagnosis codes are fully supported by medical documentation and compliant with ICD-10-CM Official Guidelines and client-specific coding instructions.
Maintain coding quality, accuracy, and productivity metrics as defined by the organization.

Employment Qualifications

Education & Certification (Required):

High school diploma or equivalent.
Completion of a certified medical coding program.

Acceptable Certifications Include

CPC, COC, CRC (AAPC)
CCS, CCS-P (AHIMA)
CPC-A with required experience is acceptable.

Active certification and continuing education/membership maintenance required.

Experience

Minimum 2 years of HCC risk adjustment coding experience, or
1 year of general medical coding experience with 2 years of clinical-related healthcare experience.

Skills, Knowledge & Abilities (SKA)

In-depth understanding of Risk Adjustment programs, including coding and data validation requirements.
Strong knowledge of ICD-10-CM coding guidelines and AHA Coding Clinic guidance.
Advanced understanding of medical terminology, pharmacology, anatomy/physiology, and disease pathology.
Ability to work efficiently across multiple lines of business, coding platforms, and EMR systems.
Excellent time management and the ability to meet deadlines with minimal supervision.
Strong attention to detail with a high level of accuracy, completeness, and production efficiency.
Clear and professional communication skills, both written and verbal.

Skills

Risk Adjustments programs coding and data Validation,Medical Terminology,Pharmacology

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