The HCC Certified Coder abstracts clinical information and assigns appropriate diagnosis and procedure codes in accordance with nationally recognized coding guidelines. This role analyzes and translates medical and clinical diagnoses in alignment with CMS Risk Adjustment Models and supports a value-based kidney care organization.
Key responsibilities include:
- Auditing patient health assessments and conducting peer coding quality reviews
- Performing prospective medical chart audits to identify, monitor, and document claims and encounter coding information related to Hierarchical Condition Categories (HCC)
- Conducting coding abstraction and chart quality audits to ensure accurate clinical documentation supports ICD-10 codes and CMS Risk Adjustment guidelines
- Educating clinicians on coding issues, documentation opportunities, and guideline updates
- Maintaining coding accuracy and production goals
- Collaborating with providers, leadership, and coding teams to develop tools, improve documentation, and support quality initiatives
Requirements & Qualifications
- CPC, CCS, or CCS-P credential required
- CRC credential required
- 3+ years of experience in a Certified Coder role
- 3+ years of experience in HCC coding
- Strong knowledge of CPT, ICD-9, ICD-10, HCPCS, modifiers, E/M code assignment, auditing, and education
- Advanced understanding of medical terminology, anatomy, and physiology
- Experience communicating and working closely with physicians
- Experience with Medicare programs and regulations, including fraud and abuse and risk adjustment
- Familiarity with STARs performance measures and metrics
- Proficiency with PC systems in a Windows environment, including Microsoft Word, Excel, PowerPoint, and electronic medical records
- Athena experience preferred
- Medical billing experience preferred
- Nephrology coding experience preferred
Benefits & Perks
- Competitive salary and eligibility for the company bonus program
- Comprehensive medical, dental, vision, and life insurance
- Flexible paid leave and vacation policy
- 401(k) plan with matching contributions
- Opportunity to work in a dynamic, innovative value-based care organization
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
1 month ago