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Coding Specialist - Community Health Choice - Quality Department
JOB SUMMARY: The Coding Specialist performs reviews of claim lines details to support the Risk Adjustment and HEDIS programs and work with Community?s Risk Adjustment and HEDIS vendors. The coding specialist will coordinate with internal and external resources in determining the appropriateness of diagnosis and procedure codes found in administrative and medical claims; review data elements to support the submissions for Risk Adjustment and HEDIS; to review and validate accuracy of HCCs identified in suspecting and RADV audit medical records; and develop reports of findings and recommendations for the Risk Adjustment and HEDIS team.QUALIFICATIONS:High School diploma or equivalent. Associate's or Bachel
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