HCC Coding Specialist

2 months ago


Long Beach, California, United States Advanced Medical Manage Full time
Job Overview

POSITION SUMMARY

The HCC Coding Specialist plays a crucial role in managing and training for Risk Adjustment HCC coding, ensuring seamless collaboration among healthcare providers, office personnel, and health plan representatives to meet organizational objectives.

KEY RESPONSIBILITIES

  • Analyze medical records to identify, gather, evaluate, and document claims and encounter coding information relevant to Hierarchical Condition Categories (HCC).
  • Conduct audits of provider documentation for CPT, ICD-9, and ICD-10 codes to ensure compliance with coding standards and CMS Risk Adjustment regulations.
  • Assess HCC auditing procedures and offer insights and recommendations to enhance provider documentation and coding accuracy.
  • Facilitate ongoing education for providers regarding HCC coding practices.
  • Engage in process and quality improvement initiatives to enhance operational efficiency.
  • Achieve productivity and quality benchmarks consistently.
  • Review Comprehensive Annual Wellness Examination (CAPE) forms as part of the coding process.
  • Perform additional duties as necessary to support the team.

EDUCATION & EXPERIENCE REQUIREMENTS

  • Bilingual proficiency in Korean is preferred but not mandatory.
  • A minimum of 2 years of experience in HCC coding is required.
  • Certification as a Medical Coder, holding either CPC or CCS credentials.
  • Familiarity with Medicare managed care practices.
  • Ability to foster positive professional relationships with providers and IPAs.
  • Exceptional verbal and written communication skills.
  • Strong organizational capabilities.
  • Proven analytical and problem-solving skills to address challenges in obtaining and validating accurate HCC information.
  • Capacity to work independently as well as collaboratively within a team.
  • Must maintain an accuracy standard of 95% or higher.
  • Proficient in Microsoft Outlook, Word, Excel, and PowerPoint.
  • Experience with Electronic Medical Records (EMR) systems.
  • Possession of a reliable vehicle and a clean, unrestricted driver's license.
  • Willingness to travel as required.


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