About the job
The Medical Record Reviewer will play a pivotal role in conducting thorough medical record reviews, whether on-site, remotely, or in-house, to support initiatives related to Medicare risk adjustment and Risk Adjustment Data Validation (RADV) Audits. This position will also contribute to the development of the medical chart review program at the client’s organization.
Duties and Responsibilities:
- Leverage expert knowledge of American Hospital Association (AHA) coding principles, including CPT, HCPCS, and ICD-9-CM/ICD-10-CM codes to assess medical record documentation pertinent to HCC risk adjustment tasks.
- Gather and document chart and coding details in alignment with Commercial Risk Adjustment and Medicare Advantage data collection protocols.
- Assist in establishing the medical chart review program, including defining operational policies, mentoring team members, and advising on infrastructure needs.
- Utilize coding expertise to guide Revenue Management strategy development and support coding education initiatives for provider offices.
- Create and maintain internal and vendor-based coding guidelines.
- Serve as a subject matter expert on coding practices, including provider education and communication efforts.
- Compile detailed reports based on data from client providers/members, ensuring accuracy and compliance with regulatory standards.
- Engage in ongoing training to maintain coding certifications and other professional credentials.
- Participate in inter-rater reliability testing as required.
- Adhere to all HIPAA regulations and patient confidentiality requirements.
- Coordinate with external and internal auditors as needed.
- Perform other duties and projects as assigned.