Medical Coder HCC, Mumbai

Job Description: HCC Coder 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 preferredRequired 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 skillsWork 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