HCC Coder

PedIM Healthcare is seeking an experienced HCC Coder to join our growing value-based care team. This role is critical to ensuring accurate risk adjustment, complete documentation, and compliance with CMS guidelines while supporting high-quality patient outcomes. 

The HCC Coder will be responsible for reviewing medical records, identifying appropriate HCC diagnoses, ensuring documentation integrity, and collaborating closely with providers and clinical teams to optimize RAF scores and coding accuracy.

What We Offer

• Competitive compensation based on experience discussed during interview
• In-house or remote flexibility
• Team-oriented, value-driven environment
• Opportunity to directly impact patient outcomes and organizational performance
• Long-term growth within a value-based care organization

Key Responsibilities

• Conduct pre-visit and chart reviews to identify known and suspected RAF/HCC conditions prior to patient appointments
• Conduct post-visit chart reviews to ensure all RAF/HCC opportunities have been captured by the medical provider prior to claims submission/billing
• Conduct post claims submission reconciliation from payer to ensure all codes have been properly accounted for through files such as MOA004, MOR and MMR
• Review provider documentation and assign accurate ICD-10 and HCC codes
• Identify documentation gaps and provide clear, actionable feedback to providers
• Track coding trends and identify performance improvement opportunities
• Collaborate closely with Clinical Integrity, Outreach, and Provider Teams
• Maintain established productivity and quality benchmarks
• Stay current with CMS risk adjustment guidelines and regulatory updates

• Minimum 2+ years of HCC/Risk Adjustment coding experience (required)
• Strong knowledge of CMS risk adjustment methodology and Medicare Advantage models
• Active coding credential preferred (CRC, CPC, CCS, or equivalent)
• Proven experience with chart audits and provider education
• Experience performing pre and post -visit RAF reviews preferred
• Strong analytical skills and attention to detail
• Experience with EHR systems required
• Value-based care experience strongly preferred

PM20