Lead Hierarchical Condition Category (HCC) Coding Specialist (Remote)
$72,700–$116,600 year
Remote · Pennsylvania, United States
Job Summary
Lead HCC Coding Specialist responsible for delivering accurate HCC coding and supporting RADV audits. The role includes conducting QA reviews of internal coders, providing education and training on CMS coding guidelines, researching and resolving coding questions, preparing documentation for regulatory audits, and mentoring new hires. Works across provider entities to analyze coding trends, present findings, and improve documentation to ensure compliant risk-adjustment capture. Remote office-based with collaboration across teams and occasional travel as needed. Requires associate-level coding credentialing, 5+ years of HCC risk adjustment coding experience, and proficiency in ICD-10 and related coding standards. Strong communication, analytical, and training skills are essential.
Required Qualifications
- Associate's degree in medical billing/coding, health insurance, healthcare or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree
- 5 years of HCC risk adjustment coding experience
- 3 years of RADV audit experience
- 3 years of Coding QA experience
- 3 years of LPN or RN experience
- 1 year of Management or leadership
- Licenses or Certifications: CPC, CRC, CCS, RHIT (any of the following)
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