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About the Role

We are looking for an experienced Medical Coder with strong expertise in US home health coding, ICD-10-CM, HCC coding, CPT coding, and OASIS assessments and updates.

The ideal candidate understands the complexities of the US home health reimbursement and compliance landscape, can interpret clinical documentation accurately, and ensures that diagnoses and codes are supported by the medical record and applicable coding guidelines.

You will work with clinical documentation and coding workflows to improve accuracy, support compliant billing, and help reduce preventable claim denials.

Key Responsibilities

• Review home health clinical documentation, including Start of Care, Resumption of Care, recertification, and follow-up assessments.
• Assign accurate ICD-10-CM diagnosis codes based on provider documentation and applicable coding guidelines.
• Apply knowledge of home health coding, including primary and secondary diagnoses, sequencing, and their impact on reimbursement.
• Demonstrate working knowledge of HCC coding and risk adjustment principles.
• Understand CPT coding and its appropriate application to relevant services and workflows.
• Stay current with OASIS updates, including OASIS-E requirements and subsequent revisions, and understand their implications for documentation and coding.
• Review OASIS assessments and supporting clinical records for completeness, consistency, and coding accuracy.
• Identify documentation gaps, conflicting diagnoses, unsupported codes, and potential compliance risks.
• Collaborate with clinical, quality assurance, billing, and operations teams to resolve coding discrepancies.
• Support coding audits, quality reviews, and initiatives to improve first-pass claim accuracy.
• Maintain compliance with applicable CMS requirements, Medicare home health regulations, and official coding guidance.
• Track changes in ICD-10-CM guidelines, CMS policies, and other relevant coding requirements.

Required Qualifications

• 3+ years of medical coding experience, preferably in the US healthcare industry.
• Strong hands-on experience with US home health coding.
• Proficiency in ICD-10-CM coding and diagnosis sequencing.
• Knowledge of HCC coding, risk adjustment, and CPT coding.
• Familiarity with OASIS assessments, including Start of Care, Resumption of Care, recertification, and discharge workflows.
• Strong understanding of Medicare home health documentation and reimbursement requirements.
• Ability to interpret clinical records and identify inconsistencies between documentation, diagnoses, and assigned codes.
• Strong attention to detail, analytical skills, and written communication.
• Ability to work independently while meeting quality and productivity targets.