Reviewing medical records and documents to abstract clinical data for HEDIS reporting Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules, and guidelines Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information Follow up with providers as necessary when responses to queries are not provided in a timely basis Utilize medical coding software programs or reference materials to identify appropriate codes Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions) Assist with ensuring that the medical record collection, review, and abstractions are complete and compliant in accordance with NCQA HEDIS technical specifications and guidelines Apply post-query response to make final determinations Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing medical records (e.g., charts, assessments, visits, encounters) Resolve medical coding edits or denials in relation to code assignment Apply understanding of National Correct Coding Edits to the coding process Demonstrate understanding of National and Local coverage determinations Demonstrate basic knowledge of the impact of coding decisions on revenue cycle Follow relevant professional code of ethics consistent with required certifications Attain and/or maintain relevant professional certifications and continuing education seminars as required Leverage relevant computer software programs (e.g., Microsoft Office) to record information, analyze data, or communicate with others Utilize and navigate across clinical software applications to assign medical codes or complete reviews