• Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify accuracy, completeness, specificity, and appropriateness of diagnosis codes • Assist with validation audits to evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS for reimbursement • Interpret medical documentation to ensure all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions applicable to Medicare Risk Adjustment reimbursement initiatives is captured • Develop tools and metrics to improve accuracy and completeness of coding and documentation • Provide a high level of customer service to internal and external clients by meeting and/or exceeding expectations including quality and productivity standards • Escalate appropriate coding audit issues to management as required • Participate in and support ad-hoc coding audits as needed • Support ongoing programs which minimize organizational risk in the event of a Risk Adjustment Data Validation (RADV) Audit • Work assigned coding projects to completion • Other duties as assigned

• Responsible for accurate and timely coding of hospital inpatient, outpatient and/or professional fee encounters using ICD10/ICDPCS, CPT, or HCPCs codes • Responsible for understanding and applying all regulatory coding guidelines • Develops methodology for a coding process compliant with regulatory agencies • Facilitates optimization of revenue while maintaining compliance standards • Serves as an expert resource regarding various coding systems and regulatory guidelines • Reports documentation and coding improvement needs based on review findings • Performs provider and peer coding audits as requested • Monitors internal controls for coding and billing

• Code medical records to validate ICD-10-CM codes for PACE Risk Adjustment • Meet department production and quality standards • Research regulatory guidelines for supporting documentation • Prepare coding reports using excel • Prepare oral and/or written reports of work activity to Supervisor • Be responsible and accountable for maintaining the confidentiality, integrity, and availability of protected health information. • Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach • Other duties as assigned

• Assigns accurate ICD diagnosis codes, using compliant documentation. • Assigns accurate CPT/HCPCS codes to records, using compliant documentation. • Applies knowledge of Coding Guidelines to select the appropriate diagnosis code. • Uses available research and reference tools to understand the disease process and diagnosis. • Interprets physician documentation within the coding guidelines and obtains clarification from physicians regarding vague or ambiguous record documentation. • Enhances coding knowledge and skills with continuing education activities as described in HIM.COD.003 policy and by reviewing pertinent literature.