Senior Encounter Data & Coding Specialist
Core
Ensures completeness, accuracy, and regulatory compliance of encounter data, diagnosis coding, and clinical documentation for CMS, Medicare, Medicaid, and PACE reporting.
Role type
Senior IC encounter data & coding specialist
Builds
Accurate encounter submissions and compliant clinical documentation for government payers
Domain
Healthcare administration / PACE program
Deliverable
dashboards & analysis
Required skills
ICD-10-CM coding, encounter data reconciliation, clinical documentation improvement, CMS reporting, root cause analysis, dashboard creation
Preferred skills
Revenue integrity, risk adjustment, provider query management
Technologies
Electronic health records, billing systems, claims systems, CMS submission reports
Responsibilities
Review, validate, and reconcile encounter data submissions; Investigate encounter rejections, edits, and denials; Perform concurrent and retrospective coding reviews; Assign and validate ICD-10-CM diagnosis codes; Identify documentation deficiencies and initiate provider queries; Create corrective action plans for coding issues; Maintain dashboards and reports related to encounter performance metrics.
