K KEERTHANA

Auditor

• Perform accurate coding of medical diagnoses using ICD-10-CM guidelines.
• Review medical records to assign appropriate codes and compliance with regulatory standards.
• Conduct detailed analysis of patient charts for completeness, accuracy, and compliance with ICD-10 standards.
• Collaborate with healthcare providers to clarify documentation for accurate code assignment.
• Maintain up-to-date knowledge of ICD-10 updates and industry coding changes.
• Perform chart reviews and data abstraction to assess quality measure performance.
• Identify care gaps and recommend corrective actions for improved HEDIS metrics.
• Collaborate with healthcare providers to ensure accurate documentation and reporting.
• Prepare and submit audit findings, ensuring adherence to deadlines and standards.
• Maintain up-to-date knowledge of HEDIS specifications and industry updates.

Roles & Responsibilities

• Accurately capture and document chronic conditions and comorbidities using HCC coding guidelines.
• Collaborate with physicians and clinical staff to ensure accurate documentation for hierarchical condition coding.
• Analyze trends in coding data and recommend strategies to improve documentation accuracy.
• Educate healthcare providers on the importance of HCC coding and its impact on quality reporting and reimbursement.
• Stay updated on CMS and payer guidelines related to HCC risk adjustment models.