HEALTH CODER - HCC & RISK ADJUSTMENT

The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operation with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization’s quality outcomes and financial performance.

ESSENTIAL JOB FUNCTIONS:

• HCC Coding and Risk Adjustment (RA) Program Support
  • Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines.
  • Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance.
  • Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy.
• Provider Training and Clinical Documentation Improvement (CDI)
• Develop and deliver provider education sessions and materials on best practices for clinical documentation and HCC/RA coding.
• Provide one-on-one and group training to physicians and clinical staff to improve documentation quality and accuracy.
• Serve as a resource and subject matter expert on HCC, risk adjustment, and related coding standards.
• Data Analysis and Reporting
  • Analyze coding data to identify trends, documentation gaps, and opportunities for improvement.
  • Generate reports and dashboards to track coding performance and documentation accuracy.
  • Collaborate with the Quality and Analytics teams to optimize risk adjustment processes.
• Compliance and Continuous Improvement
  • Stay up to date with changes in coding, risk adjustment, and Medicare regulations.
  • Assist in the development and implementation of internal coding policies and procedures.
  • Participate in quality improvement initiatives related to coding and documentation.
• Performs other job duties as required by manager/supervisor

QUALIFICATIONS:

• Education & Certification:
  • BS/BA Degree in Health Science or General Education is highly preferred; completion of a two-year degree is preferred. 
  • Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification required.
  • Additional CDI or auditing certifications (CCDS, CDEO, CPMA) preferred.
• Experience:
  • 3+ years of experience in medical coding with a focus on HCC, risk adjustment, and Medicare Advantage programs.
  • Experience in provider education, clinical documentation improvement (CDI), and chart audits.
  • Previous experience working in an IPA, managed care organization, or similar setting strongly preferred.
• Skills & Competencies:

• Excellent communication, presentation, and interpersonal skills.
• Strong understanding of CMS guidelines for Medicare Advantage and risk adjustment program.
• Exceptional knowledge of ICD-10-CM coding and HCC risk adjustment coding methodologies.
• Proficiency in electronic health records (EHR) and coding software.
• Strong analytical and problem-solving skills.

LANGUAGE:

• Must be able to fluently speak, read and write English.
• Fluent in Chinese (Cantonese and/or Mandarin) preferred
• Fluency in other languages are an asset.

STATUS:

• This is an FLSA Non-exempt position.
• This is not an OSHA high-risk position.