Risk Adjustment/Coding Toolkit
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Coding Specialist
Perform onsite or electronic audits of medical records/claims to ensure proper medical diagnoses are being submitted for reimbursement. Responsible for the validation of diagnosis codes as well as the identification of missing diagnoses codes submitted on the claim and more.
Risk Adjustment Quality Assurance and Compliance Procedure Manual
To ensure quality submission of HCC codes to the Center for Medicare & Medicaid Services (CMS) by auditing prospective and retrospective chart reviews.
CMS Contract-Level Risk Adjustment Data Validation Medical Record Reviewer Guidance - September 2017
The Contract-Level Risk Adjustment Data Validation (RADV) Medical Record Reviewer Guidance has been created to provide information on the RADV medical record process. These guidelines are used by coders to evaluate the medical records submitted by plans to validate audited diagnoses.