Medical Coder

• Job Title: Quality Assurance Coder/Auditor
• Location: Hybrid (1 - Day in office) / (Can be Fully remote for Arizona's candidate)
• Schedule: Full-Time | Monday – Friday | 8:00 AM – 5:00 PM ET
• Vacancy Type: FTC - 6 months with Option to Extend or Convert to Permanent
• Pay Rate: $46.07 per hour without benefits

We are seeking an experienced Quality Assurance Coder/Auditor to support risk adjustment, HCC coding quality, auditing, and provider education initiatives. This individual will review medical records and supporting documentation to ensure accurate, complete, and compliant diagnosis coding in accordance with ICD-10, CMS, Medicare Managed Care, and risk adjustment guidelines.

The Coder/Auditor will perform quality audits of provider and vendor-submitted HCC data, identify coding and documentation deficiencies, recommend corrective actions, and develop educational materials for providers and coding staff. This role requires strong knowledge of HCC coding methodologies, risk adjustment models, coding guidelines, and medical record documentation requirements.

• Review and audit medical records, diagnoses, and supporting documentation for coding accuracy and completeness.
• Perform HCC coding and risk adjustment quality assurance audits.
• Validate diagnosis codes and ensure coding is supported by appropriate face-to-face encounters and valid documentation.
• Identify coding errors, unsupported diagnoses, documentation gaps, and risk mitigation opportunities.
• Conduct QA audits of vendor and supplemental HCC data submissions and provide corrective action recommendations.
• Track audit findings and prepare monthly reports and updates for management and vendor teams.
• Develop and deliver provider and coder education related to coding accuracy, documentation improvement, and healthcare gap closure.
• Prepare educational materials, written communications, and PowerPoint presentations.
• Maintain current knowledge of ICD-10, CMS risk adjustment methodologies, Medicare Managed Care Manual Chapter 7, and related regulations.
• Correct encounter rejections and support resolution of coding-related issues within vendor platforms.

• Minimum 5 years of professional medical coding experience.
• Minimum 3 years of HCC/risk adjustment coding experience.
• Minimum 2 years of HCC auditing or quality assurance experience.
• Advanced knowledge of ICD-10 coding guidelines and HCC methodologies.
• Strong understanding of CMS risk adjustment models and ICD-to-HCC crosswalks.
• Knowledge of Medicare Managed Care and Chapter 7 – Risk Adjustment requirements.
• Experience reviewing and auditing medical records and clinical documentation.
• Strong written and verbal communication skills.
• Experience developing training materials and educating providers or coding teams.
• Ability to prepare and present PowerPoint presentations.
• Proficiency with Microsoft Word, Excel, and PowerPoint.
• High School Diploma or GED.

Candidates must hold at least one of the following certifications:

• CPC – Certified Professional Coder

• Knowledge of RADV (Risk Adjustment Data Validation) processes.
• Pharmacology knowledge.
• Experience with Medicare Advantage or managed care populations.

Pride Global and its affiliates offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.

Pride Global and its affiliates are an equal opportunity employer. We do not discriminate on the basis of the race,…