Medical Coder
Company: AHIPL Agilon Health India Private Limited
Location: Bangalore, India
Employment Type: Full-Time
Job Requisition ID: R003654
Function: Medical Coding / Healthcare Operations
Position Overview
Agilon Health India is seeking a Medical Coder to support accurate and compliant medical coding activities. The role involves reviewing medical records, validating diagnosis and procedure codes, identifying appropriate CMS-HCC and HEDIS-related coding, and ensuring clinical documentation supports the assigned codes.
The Medical Coder will apply knowledge of medical terminology, anatomy, physiology, coding guidelines, and healthcare reimbursement requirements to ensure coding accuracy and completeness.
Key Responsibilities
Medical Record Review and Coding
Review medical records and clinical documentation to identify appropriate diagnosis and procedure codes.
Verify the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered.
Review documentation to identify all applicable codes under the CMS-HCC model.
Identify appropriate HEDIS exclusion codes that are not captured within the CMS-HCC model.
Review medical records to identify appropriate CPT Category II (CPT II) procedure codes.
Ensure selected codes accurately reflect the services and conditions documented in the medical record.
Apply appropriate coding guidelines and standards during the review process.
Clinical Documentation and Coding Analysis
Apply knowledge of basic anatomy and physiology to interpret clinical documentation.
Identify applicable clinical codes based on documented diagnoses, conditions, procedures, and services.
Analyze medical records to identify potential gaps or inconsistencies affecting HCC accuracy.
Demonstrate strong analytical and problem-solving skills when evaluating HCC information.
Identify barriers to obtaining and validating accurate risk-adjustment information.
Coding Tools and Systems
Utilize medical coding software, coding references, and other applicable resources to determine appropriate codes.
Complete required system entries related to claims and encounter information.
Maintain accurate and complete coding documentation within applicable systems.
Ensure coding activities and system updates are completed within established timelines.
Provider Queries
Prepare provider queries in accordance with AHIMA and ACDIS guidelines when clarification of clinical documentation is required.
Ensure queries are appropriate, compliant, and supported by available documentation.
Review provider responses and apply appropriate information to the final coding determination.
Maintain accurate records of query activity and outcomes.
HCC Tracking and Management
Maintain comprehensive tracking and management tools for HCC-related activities.
Monitor assigned tasks and ensure completion within required timelines.
Track coding activities, outstanding items, queries, and resolutions.
Identify delays, barriers, and recurring issues and communicate them to leadership.
Quality, Compliance, and Education
Maintain current knowledge of medical coding guidelines and reimbursement regulations.
Stay informed about changes to coding standards, CMS requirements, HCC models, HEDIS requirements, and applicable regulations.
Participate in ongoing training and education within assigned timelines.
Maintain high standards of coding quality, accuracy, completeness, and compliance.
Communicate coding-related issues and process barriers to leadership.
Support initiatives designed to improve coding accuracy and overall process quality.
Mentoring and Collaboration
Educate and mentor colleagues to improve medical coding quality.
Share coding knowledge, best practices, and process updates with team members.
Collaborate with leadership and other stakeholders to resolve coding and documentation issues.
Support team objectives and contribute to a culture of continuous improvement.
Auditing and Special Projects
Participate in special project audits as required.
Support quality assurance and coding audit activities.
Assist with identifying trends and opportunities for improvement based on audit findings.
Perform additional responsibilities and duties assigned by leadership.
Required Knowledge and Skills
Knowledge of medical terminology.
Basic understanding of anatomy and physiology.
Understanding of diagnosis and procedure coding principles.
Knowledge of CMS-HCC coding and risk adjustment concepts.
Understanding of HEDIS coding and exclusion requirements.
Knowledge of CPT Category II coding.
Familiarity with medical coding software and reference tools.
Understanding of AHIMA and ACDIS-compliant provider queries.
Strong analytical and problem-solving abilities.
Excellent attention to detail.
Strong organizational and time-management skills.
Ability to manage multiple coding activities and meet deadlines.
Good written and verbal communication skills.
Ability to work effectively independently and as part of a team.
Ideal Candidate Profile
The ideal candidate is a detail-oriented medical coding professional with strong clinical documentation review skills and a good understanding of healthcare coding, CMS-HCC, HEDIS, and CPT II requirements.
The candidate should be comfortable reviewing complex medical records, identifying appropriate codes, preparing compliant provider queries, and maintaining accurate coding documentation. A strong commitment to quality, regulatory compliance, and continuous learning is essential.
Additional Responsibilities
Complete all assigned activities within established timelines.
Communicate process issues and barriers to leadership.
Participate in training, quality initiatives, audits, and special projects as required.
Perform other duties as assigned by leadership.
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