Role Description Responsible for reviewing clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM/CPT4 codes and modifiers for billing, internal and external reporting, research, and regulatory compliance. Accurately code conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting. Typically reports to Coding Manager. Qualifications - High School Diploma or GED required; Associate Degree in medical area preferred. - One of the following licenses is required: - Certified Coding Specialist (CCS) - Certified Professional Coder (CPC) - Registered Health Information Technician (RHIT) - Registered Health Information Administrator (RHIA) - Certified Medical Coder (CMC) - Certified Coding Associate (CCA) - Two (2) years outpatient coding experience required; six (6) months of HCC experience preferred. - Ability to code multi-specialties for physicians including E&M Levels. - Effective oral and written communication skills. Requirements - Assigns codes for diagnoses, treatments, and procedures according to the appropriate classification system for outpatient encounters. - Utilizes technical coding principles and APC reimbursement expertise to assign appropriate ICD-10-CM diagnoses, CPT 4, E&M Levels, and modifiers. - Reviews documentation to extract and enter data accurately for other abstracting fields. - Follows coding compliance policies, official coding guidelines, regulatory requirements, and internal policies and procedures affecting the coding process. - Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines. - Ensures safe care to patients, staff, and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity, and quality of service. - Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff. - Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized, and efficient experiences to patients and colleagues. - Other duties as assigned.

Role Description The Risk Adjustment Coder conducts quality assurance coding of medical records and ICD-10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Coder assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. - Ensures coding is accurate and properly supported by clinical documentation within the health record. - Reviews medical records to report conditions that map to HCCs by reviewing medical record documentation and applying the appropriate ICD-10 diagnosis codes. - Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. - Works on projects that may include making phone calls to providers. - Works within broad guidelines with little oversight. - Demonstrates a professional demeanor, strong work ethic, and is a reliable team player with a positive attitude. - Utilizes effective written and verbal communication skills. - Demonstrates proficiency in using computers and relevant technology including the ability to navigate multiple software applications and perform tasks using digital tools. - Participates on special projects, in addition to daily responsibilities. - May be required to work mandatory overtime to meet business needs and ensure timely completion of operational tasks. Qualifications - At least one of the certifications from AAPC or AHIMA are required from the following list: - CPC or CPC-A - Certified Professional Coder (AAPC) - COC - Certified Outpatient Coder (AAPC) - CIC - Certified Inpatient Coder (AAPC) - CRC - Certified Risk Coder (AAPC) - CCA - Certified Coding Associate (AHIMA) - CCS - Certified Coding Specialist (AHIMA) - CCS-P - Certified Coding Specialist-Physician Based (AHIMA) - Experience working in a goal-oriented environment that is production and quality driven. - Must maintain annual continuing education requirements and remain in good standing with the coding credentialing body, AAPC or AHIMA. - Must be able to work 40 hours a week, Monday – Friday, with the ability to work mandatory overtime as needed to support business needs. - Must have a confidential work space in order to work effectively and independently without distractions. - Proficient using relevant technology including the ability to navigate multiple software applications and perform tasks using digital tools. Requirements - Proficient in the use of Microsoft Office systems Word and Excel. - Risk Adjustment Experience. - HCC Coding experience. - While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Benefits - Medical, dental and vision benefits. - 401(k) retirement savings plan. - Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave). - Short-term and long-term disability. - Life insurance. - Many other opportunities.

• Ensures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture. • Assigns diagnostic and procedure codes to simple record types up to highly complex record types. • Organizes and prioritizes assigned work to ensure that work is completed within the assigned time frame. • Reviews charts and entire medical records, assigning ICD and CPT code combinations to each data element. • Audits for documentation opportunities and queries clinical staff to fill in any gaps to clarify confusing, incomplete or conflicting information and obtain any needed additional documentation. • Contacts and works with physicians as needed for clarification of details to ensure correct coding. • Accurately utilizes the ICD-10-CM classification system and CPT classification system in assigning diagnostic, procedural and complication codes to all claims while meeting billing requirements of various payers.

• Assists with development of education/training materials • Coordinates training and development of staff • Provides technical training in usage of information systems • Conducts skill assessments and orientation for new hires • Develops and maintains education calendars and records • Provides onsite support for trainees • Collaborates with teams to develop educational materials • Monitors clinical documentation for coding accuracy