Role Overview
Responsible for Medicare and Accountable Care Act (ACA) Risk Adjustment chart and claim review and analysis to ensure appropriateness and accuracy of ICD-10 coding in relation to risk adjustable coding.
Promotes consistency and accuracy of risk adjustable coding and documentation practices and ensures that clinical services ordered and performed are accurately coded based on documentation and governmental regulations.
Responsible for analyzing coding and documentation. Responsible for retrospective chart and claim coding review. Identifies coding errors and recommends correct coding and terminology usage based on ICD-10-CM in accordance with regulatory agencies and specific guidelines.
Performs ongoing data analysis to identify opportunities to improve, and recapture risk adjustable diagnoses. Identifies and communicate trends to the appropriate teams, including Professional Coding Leadership.
Follows the necessary schedules for team assignments of documentation/coding accuracy. Conducts required, timely Medicare and ACA Risk Adjustment chart reviews and generates summary reports for client. Develops mechanisms to identify specific coding issues related to Medicare and ACA Risk Adjustable coding to allow for follow-up reviews to identify improvement/correction of those elements for which the physician has received education.
Utilizes monitoring tools or other applications to track and report the progress of the Clinician Documentation & Coding Accuracy Plan. Maintains a current understanding of regulatory trends and changes in coding policy and reimbursement that affect the organization by monitoring governmental resources to assess regulatory changes and determine organizational impact.
Maintains up-to-date knowledge of Medicare, ACA, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards. Assist with validation of HCCs as requested by external entities. Conducts Risk Adjustment Validation Audits (RADV) when required by regulatory agencies and participates in quality validation audits from 3rd party vendors/agencies. Assigns appropriate ICD–10-CM codes, mapping to risk adjustment models as applicable.
Identifies and flags encounters when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes. Identifies, evaluates and acts to resolve any barriers to meeting documentation standards. Remains current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirements.
Work you'll do
As a Senior Consultant on the Regulatory Healthcare team, you will be responsible for supporting Medicare and ACA risk adjustment coding reviews, analyzing documentation, and helping clients improve coding accuracy and compliance.
- Review medical charts and claims to assess the appropriateness and accuracy of ICD-10-CM coding for risk adjustment.
- Perform retrospective coding and documentation reviews to identify errors, gaps, and opportunities to recapture risk-adjustable diagnoses.
- Analyze coding and audit results, identify trends, and prepare summary reporting for client and internal stakeholders.
- Support RADV activities, HCC validation requests, and other regulatory or quality validation reviews.
- Monitor coding policy, reimbursement, and regulatory updates and apply changes to audit, documentation, and coding review activities.
The team
Deloitte provides you an opportunity to gain valuable hands-on experience working alongside leading professionals across diverse industries while building your professional skills in a variety of project experiences. Our Deloitte practice helps organizations effectively navigate business risks and opportunities—from strategic, reputation, and financial risks to operational, cyber, and regulatory risks—to gain competitive advantage. We apply our experience in ongoing business operations and corporate lifecycle events to help clients become stronger and more resilient. Our market-leading team’s help clients embrace complexity to accelerate performance, disrupt through innovation, and lead in their industries.
Location: Hyderabad
Shift Timings: 11 AM to 8 PM or 2 PM to 11 PM IST
Qualifications
Required:
- 8+ years of experience in HCC coding, risk adjustment coding, or RADV review
- Active coding certification from the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC), such as CRC, CCS, CPC, or COC
- Experience performing ICD-10-CM coding review and analysis for Medicare and ACA risk adjustment charts and claims
- Experience using the Centers for Medicare & Medicaid Services (CMS)-HCC Risk Adjustment Model and CMS coding and documentation guidelines
- Experience performing coding audits for inpatient, outpatient, and/or professional claims
- Experience using electronic medical record systems and encoder tools such as Epic, 3M, or TruCode
- Advanced proficiency in Microsoft Excel and Microsoft PowerPoint
Preferred:
- Prior consulting experience
- Degree in medicine or an allied healthcare field