Clinical Documentation & Coding Specialist

High school diploma required; Associate’s or Bachelor’s degree in a health-related field preferred Active CPC or CCS certification (AAPC or AHIMA) CRC certification strongly preferred 2–3+ years of medical coding experience 1–2 years in HCC/risk adjustment Demonstrated experience performing detailed pre-visit chart preparation Experience coding neurology, psychiatry, behavioral health, or dementia conditions (strongly preferred) Strong understanding of ICD-10-CM, HCC models, MEAT criteria, and CMS/HHS risk adjustment principles Ability to analyze medical records, identify unsupported diagnoses, and detect coding gaps Excellent communication skills for provider interaction and compliant query writing Proficiency with coding software, EHR platforms, and technology tools Ability to work independently, maintain accuracy under volume, and meet tight deadlines

Perform comprehensive chart preparation for dementia-care patients Identify suspected, undocumented, or insufficiently supported chronic conditions Review medical records for documentation gaps and flag issues Accurately assign ICD-10-CM codes compliant with CMS HCC guidelines Validate diagnoses meet MEAT documentation standards Review post-visit documentation to reconcile diagnoses Query providers for clarification when documentation is incomplete Provide feedback and education to providers on documentation needs Collaborate with revenue cycle, CDI, and auditing teams Maintain high accuracy and productivity benchmarks Participate in internal and external audits Stay current with CMS, HHS, and payer-specific risk adjustment updates Ensure CPT/HCPCS/ICD-10 coding for encounter-based services is accurate and compliant