HCC & ProFee Coder

Title:

HCC & Pro Fee Coder

Location:

Remote Job Type: Contract to Hire Compensation: $30.00 per hour (W2) Industry: Hospital & Healthcare

Our firm is recruiting on behalf of a healthcare services client that supports health plans, provider organizations, and value-based care initiatives through advanced coding, risk adjustment, and documentation review services. We are seeking an experienced HCC & Pro Fee Coder to perform high-level coding validation, risk adjustment auditing, and clinical documentation review activities. This role is ideal for a coding professional with deep expertise in CMS HCC, Rx HCC, ICD-10-CM, and Medicare coding guidelines who thrives in a detail-oriented, quality-focused environment.

The HCC & Pro Fee Coder is responsible for reviewing medical records to validate coding accuracy, ensure compliance with regulatory guidelines, and support risk adjustment and quality improvement initiatives. The position requires extensive knowledge of ICD-10-CM coding, HCC methodologies, provider documentation standards, and coding compliance requirements.

• Review and validate diagnosis codes to ensure they are supported by clinical documentation and compliant with ICD-10-CM Official Coding Guidelines.
• Verify coding accuracy in accordance with project-specific coding and documentation requirements.
• Perform CMS HCC risk adjustment code validation and data abstraction review.
• Perform Rx HCC risk adjustment code validation and data abstraction review.
• Review CPT Category II coding and supporting documentation for accuracy and completeness.
• Apply Medicare Annual Wellness Visit coding and documentation guidelines.
• Enter coding and audit data accurately into client systems and reporting tools.
• Evaluate provider documentation quality and identify opportunities for clinical documentation improvement.
• Communicate with providers as needed to obtain coding clarification or missing documentation.
• Maintain a minimum coding accuracy rate of 96% and successfully meet quality standards during onboarding and ongoing audits.
• Collaborate with project leadership regarding assignments, workload management, schedule updates, and coding-related questions.
• Accurately document time worked and complete required administrative tasks.
• Ensure compliance with HIPAA, protected health information (PHI) requirements, and all applicable privacy regulations.
• Adhere to federal and state regulations, coding standards, and industry best practices.
• Perform additional duties as assigned.

Current AAPC or AHIMA credential, including one of the following: CPC (Certified Professional Coder) COC (Certified Outpatient Coder) CCS-P (Certified Coding Specialist - Physician-Based) Minimum 5 years of HCC-specific coding experience. Extensive experience with: ICD-10-CM coding CMS HCC risk adjustment Rx HCC risk adjustment CPT Category II coding Medicare Annual Wellness Visit coding Recent professional experience coding E/M services and ICD-10-CM diagnoses.

Strong understanding of CMS and HHS HCC hierarchies and risk adjustment models. Advanced knowledge of medical terminology, anatomy, and clinical documentation requirements. Experience researching and applying coding regulations, guidelines, and compliance standards. Experience using coding audit and review software. Proficiency with Microsoft Excel, Word, and electronic medical record (EMR) systems. Exceptional attention to detail with strong written and verbal communication skills.

Excellent organizational, time management, and prioritization abilities. Ability to work independently while maintaining high productivity and accuracy standards. Professional, positive, and collaborative approach to work. Preferred CRC (Certified Risk Adjustment Coder) credential. Additional experience in risk adjustment auditing, provider education, and documentation improvement initiatives. Experience supporting quality improvement or value-based care programs. Multi-specialty physician coding experience. Familiarity with a variety of EMR platforms and healthcare technology tools.

Our partner offers a comprehensive benefits package for full-time team members, including medical, dental, and vision insurance; company-paid life insurance; and a 401(k) retirement plan with company match. Employees also receive a phone and internet stipend, generous paid time off, seven company-observed holidays, and two floating holidays for personal observance. Additional perks include…