Transforming HCC Coding with Healthcare‑Specific Language Models
Accurate HCC coding is critical for patient risk adjustment and can have a material impact on the revenue integrity of healthcare systems and payers. Multiple studies have shown that one third to one half of patients can have evidence of prior conditions, complications, or severity in their clinical notes that are not reflected in claims or EHR problem lists. This talk presents an automated solution which automates the discovery of missed clinical codes from free‑text patient notes, prioritizes them based on their potential impact to each patient’s risk adjustment score, and provides a human‑in‑the‑loop validation tool for manual review and audit. Its key benefit is enabling organizations bring AI‑powered HCC coding in‑house – empowering existing teams with greater control, scalability, and cost efficiency. The solution architecture is based on a combination of state‑of‑the‑art, healthcare‑specific language models by John Snow Labs. A technical deep dive will share lessons learned from combining LLM and NLP models to deliver the accuracy, scalability, and explainability that were required by the enterprise who have deployed it.

About the speaker

Ritwik Jain

Ritwik Jain

Director of Payers at John Snow Labs

Ritwik serves as the Director for Healthcare Payers at John Snow Labs, where he has
spent the last four years leading the adoption of NLP and Generative AI solutions. With rich experience in AI and cloud technologies, he previously supported enterprises in migrating to Microsoft Azure to scale their data and AI capabilities. At John Snow Labs, Ritwik has collaborated with many of the top 20 largest healthcare payer organizations, delivering state-of-the-art AI solutions for critical use cases such as claims processing, prior authorization, risk adjustment, and accelerated underwriting. His expertise focuses on aligning technical innovation with business outcomes, enabling healthcare payers to enhance efficiency, accuracy, and scalability through healthcare-specific NLP and LLMs.

Hasham Ul Haq

Hasham Ul Haq

Sr Machine Learning Engineer
at John Snow Labs

NLP-Summit

When

Sessions: April 2nd – 3rd 2024
Trainings: April 15th – 19th 2024

Contact

nlpsummit@johnsnowlabs.com

Presented by

jhonsnow_logo