HCC Coder

This is a fully remote position, open to applicants in Florida.

📋 Description

• Assesses risk adjustment codes to ensure their accuracy, consistency, and alignment with established coding standards and best practices.

• Safeguards patient records and audit data by ensuring adherence to HIPAA, privacy, and regulatory standards.

• Conducts retrospective and prospective chart reviews to guarantee precise risk adjustment reporting.

• Confirms and ensures the accuracy, completeness, specificity, and appropriateness of provider-reported diagnosis codes as per medical record documentation.

• Analyzes medical record information to ensure comprehensive and accurate capture of diagnosis codes based on CMS HCC categories.

• Keeps abreast of relevant regulatory requirements and ensures that activities comply with these standards.

• Contributes to audit and production efforts to align with business demands and workload priorities.

• Provides written and verbal guidance on coding inaccuracies to colleagues.

• Achieves audit deliverables within set timelines and deadlines.

• Supports special projects, including risk mitigation reviews.

• Acts as a subject matter expert regarding the risk adjustment process and diagnosis coding for risk adjustment.

⛳️ Requirements

• A minimum of 7 years of relevant professional experience. All applicable experience, including work, education, transferable skills, and military experience, will be taken into account.

• At least 5 years of HCC coding experience utilizing inpatient and outpatient coding guidelines.

• A minimum of 5 years of experience auditing Risk Adjustment records.

• At least 1 year of experience in a Production environment.

• CRC (Certified Risk Coder) certification in good standing.

• Intermediate knowledge of risk adjustment models for Medicare, ACA Commercial, and Medicaid.

• Proven ability to apply critical thinking skills in interpreting and implementing coding policies.

• Experience in providing written and verbal guidance on coding errors and trends.

• Proficient in MS Office (Word, Excel, PowerPoint & Outlook) at an intermediate level or higher.

• Strong organizational skills to manage multiple projects and perform effectively in a deadline-driven environment.

• High school diploma (or equivalent) and legal authorization to work in the U.S.

🏝️ Benefits

• Medical, dental & vision coverage.

• Critical Illness, Accident, and Hospital insurance.

• 401(k) Retirement Plan with options for pre-tax and Roth post-tax contributions.

• Voluntary Life Insurance & AD&D for both employees and dependents.

• Short-term and long-term disability coverage.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

• Paid Time Off/Leave (PTO, Vacation, or Sick Leave).