Role Overview
Responsible for Medicare and Accountable Care Act (ACA) Risk Adjustment chart and claim review and analysis to ensure appropriateness and accuracy of ICD-10 coding in relation to risk adjustable coding. Includes expertise in Outpatient Clinical Documentation Integrity (OP CDI) to support accurate, complete, and compliant documentation and coding in the outpatient/ambulatory setting for risk adjustment purposes.
Work you'll do
As a Senior Consultant or equivalent on the Deloitte Consulting team, you will be responsible for supporting risk adjustment coding, outpatient clinical documentation integrity, and regulatory compliance activities for healthcare clients.
- Conduct Medicare and ACA risk adjustment chart and claim reviews to assess the accuracy and appropriateness of ICD-10-CM coding and HCC capture.
- Perform retrospective coding and documentation analysis to identify errors, documentation gaps, and opportunities to improve risk-adjustable diagnosis capture.
- Apply outpatient clinical documentation integrity (OP CDI) practices, including compliant query processes, to clarify documentation supporting risk-adjusted conditions.
- Monitor coding policy, reimbursement, and regulatory updates and assess their impact on client deliverables, coding accuracy, and reporting requirements.
- Prepare review summaries, trend analyses, and client-ready reporting, and support education for providers, coding staff, and internal stakeholders.
The team
Deloitte’s consulting provides you an opportunity to gain valuable hands-on experience working alongside leading professionals across diverse industries while building your professional skills in a variety of project experiences. Our practice helps organizations effectively navigate business risks and opportunities—from strategic, reputation, and financial risks to operational, cyber, and regulatory risks—to gain competitive advantage. We apply our experience in ongoing business operations and corporate lifecycle events to help clients become stronger and more resilient. Our market-leading team’s help clients embrace complexity to accelerate performance, disrupt through innovation, and lead in their industries.
Location: Hyderabad, Chennai
Shift Timings: 11 AM to 8 PM IST
Qualifications
Required:
- 8+ years of experience in HCC risk adjustment coding, including Medicare and ACA risk adjustment review
- Experience performing coding audits for outpatient, inpatient, and/or professional claims
- Experience with outpatient clinical documentation integrity (OP CDI) review in ambulatory and outpatient settings
- Coding certification from the American Health Information Management Association (AHIMA) and/or the American Academy of Professional Coders (AAPC), such as CRC, CCS, CPC, COC, or CCDS
- Knowledge of ICD-10-CM coding guidelines, CMS-HCC risk adjustment models, AHA Coding Clinic guidance, and AHIMA query practice guidelines
- Experience using electronic medical record systems and coding tools such as Epic, 3M, or TruCode
- Proficiency in English oral and written communication
Preferred:
- Prior consulting experience
- Degree in medicine or an allied healthcare field
- Experience supporting value-based care models, including Accountable Care Organizations (ACO) or Medicare Advantage
- Experience analyzing OP CDI metrics, including query volumes, response rates, agreement rates, and HCC recapture rates
- Proficiency with Microsoft Excel and Microsoft PowerPoint