HCC Coder / Prospective Clinical Reviewer

Required Qualifications:
Candidates must meet all the following:
Registered Nurse (RN/USRN) or MBBS graduate.
Minimum of 3 years of experience in prospective outpatient Clinical
Documentation Improvement (CDI), clinical documentation review, medical record review, utilization review, clinical quality, or a related clinical review function
Working knowledge of clinical documentation requirements and ICD-10-CM diagnosis terminology and principles.
Experience reviewing outpatient physician documentation and longitudinal medical records.
Prior exposure to risk adjustment or HCC coding concepts is preferred but not required. Candidates without direct risk adjustment experience must successfully complete project-specific HCC training and competency assessment
Ability and willingness to complete project-specific training in prospective risk adjustment, HCC concepts, LLM training methodology, and suspect identification
Experience with AI-assisted clinical documentation, abstraction, annotation, model validation, or coding workflows is a plus. (Preferred but not required)
Certification such as CCDS or CDIP (Preferred but not required)

Work arrangement
Yes