HEDIS Coder/Abstractor

Description
We're looking for a HEDIS Coder/Abstractor, working in Insurance industry in Texas, United States.
• Review medical records and document to abstract clinical data for HEDIS reporting.
• Identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes.
• Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules, and guidelines.
• Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes.
• Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes.
• Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information.
• Follow up with providers as necessary when responses to queries are not provided in a timely basis.
• Utilize medical coding software programs or reference materials to identify appropriate codes.
• Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions).
• Assist with ensuring that the medical record collection, review, and abstractions are complete and compliant in accordance with NCQA HEDIS technical specifications and guidelines.
• Apply post-query response to make final determinations.
• Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process.
• Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations.
• Record information, analyze data, or communicate with others.
• Utilize and navigate across clinical software applications to assign medical codes or complete reviews.

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