• Serves as a SME of Risk Adjustment programs ensuring compliance with all applicable rules and regulations for execution of CMS MRA programs• Conduct internal audits of medical record documentation supporting MRA data capture, CV coding, and retrospective review including claims billed to Medicare and other federal programs • Prepare reports from audit results and present the results to coders, providers, vendors, and/or MRA leadership.• Respond independently to questions from physicians, practice managers, executive leaders, coders, clinical reviewers, other market staff regarding billing, coding, and documentation• Develop educational programs for coders and/or providers based on audit findings along with general education on coding and documentation rules and regulations• Thorough knowledge of government regulations relating to medical records documentation and reimbursement including Medicare, Medicaid, and other industry billing standards.

• Reviews and audits coding in support of Risk Adjustment programs ensuring compliance with all applicable rules and regulations for execution of HHS’ RA programs• Ensure accurate and timely medical code abstraction for risk adjustment activities, supporting early identification and correction of errors and trends while meeting accurate data submission requirements • Collect, analyze and organize findings with regard to RA data and coding initiatives, collating potential solutions or remedies, and presenting findings and recommendations to peers, leaders, and matrix partners• Reviews current policies and procedures and recommends amendments or changes to current policy to improve compliance • Develops and implements coding education curriculum for internal coders, vendors coding teams, and provider partners, as appropriate, to improve understanding of and execution of coding guidelines

Provide aid and support to Coding Director surrounding risk adjustment clinical coding related assignments Supply expertise and knowledge in relation to clinical coding that abide to risk adjustment models, as needed, in various assignments while upholding production and accuracy of 95% Analyze and audit medical records and physician documentation to determine all appropriate ICD-9/10-CM coding based on CMS regulations and client specific guidelines

Conduct audits of medical records to ensure the codes captured are accurate and complaint that are supported by clinical documentation and adhere by CMS regulationsUphold standards of compliance, internal policies/procedures, and CMS documentation requirements for the purpose of risk adjustmentProvide education to vendor/provider based on medical documentation for missed opportunities and/or areas of improvement Accommodate team members or other associated departments when support is requested or needed

Educate coding staff regarding ethics, coding clinic, and effective improvement procedures for best coding practices and guidelines according to CMS regulations and client specific guidelines Conducted peer reviews to ensure compliance with coding guidelines and CMS regulations and documentation requirements Effectively audit medical records to ensure optimal quality, noting any documentation deficiencies and completing statistical reports for logging error trends

Assist coders to reach goal of 95% accuracy while maintaining coding productions standards. Raised accuracy by more than 20% Coach/Mentor via web-ex or one on one meetings. Successfully prepared a technique/reference guide for facility coding to ensure accuracy while upholding production standards.

HCC/Risk Adjustment inpatient/outpatient setting Maintain 97% accuracyUtilize my knowledge and gained experience to apply the correct codes within the specified guidelines.Review and validate new revenue generated.Evaluated ICD-9/10-CM codes within medical record, assigning appropriate codes that are supported with clinical documentation according to CMS guidelines and Hierarchical Condition Category criteria