[Hiring] HCC & ProFee Coder @Managed Resources

Role Description

The HCC and ProFee Coder is responsible for accurately abstracting data into appropriate client data systems, following the Official Guidelines for Coding and Reporting as well as Risk Adjustment guidelines for data collection. Client-specific guidelines may also contribute to the coding and validation process. This role will be responsible for reviewing a patient’s complete record and assigning ICD-10-CM codes and specifically those mapping to HCCs, for completeness and accuracy. In addition to HCC coding responsibilities, this role may also include Evaluation and Management (E/M) coding, depending on business needs.

Why This Role Matters

The HCC & ProFee Coder role is an important part of the organization because it bridges accurate coding with value-based care. By ensuring chronic conditions are fully documented and coded compliantly, HCC coders help clients receive appropriate risk-adjusted reimbursement, improve the quality of their clinical data, and support better care for high-risk patients.

What You’ll Gain

• Flexibility of a remote work environment
• Visibility and access to leadership
• Opportunity to contribute ideas and influence change
• Professional development and career growth opportunities
• Meaningful work supporting healthcare organizations nationwide
• A collaborative culture that values employee success, recognition, and work-life balance

What You’ll Do

• Verify that the codes captured are supported by the documentation within the record and are properly coded following ICD-10-CM official coding guidelines.
• Verify that the codes captured are supported by the documentation within the record and are properly coded following client specific guidelines for the project.
• Verify (CMS HCC) Risk Adjustment ICD-10-CM codes and Data Abstraction Rules.
• Verify Rx HCC Risk Adjustment ICD-10-CM codes and Data Abstraction Rules.
• Verify CPT Category II correct documentation and coding.
• Knowledge of Medicare Annual Wellness Visit Coding and Documentation Guidelines.
• Enter coding data into the client's system or other required formats.
• Evaluate the overall quality of physician documentation for quality improvement measures.
• Query physicians as needed (i.e. coding clarification, missing documentation, etc.).
• Must maintain a 96% coding accuracy rate in all coding areas listed above and must pass new hire onboarding QA at 100%.
• Communicate with Project Manager as needed (i.e. schedule changes, daily assignments/work volume, coding questions, etc.).
• Track and enter time accurately and timely into our timekeeping system.
• Comply with policies regarding the use and disclosure of protected health information which includes accessing and using protected health information only to the extent necessary to fulfill the above-mentioned responsibilities.
• Adhere to and comply with federal and state laws, regulations, and standards related to health information and coding principles.
• Other duties as assigned.

What You’ll Bring

• Must have one of the following current credentials from AAPC or AHIMA; CPC, COC, or CCS-P.
• HCC Risk Adjustment credential is preferred (CRC).
• Must have at least 7+ years of HCC specific coding experience including ICD-10-CM, CMS HCC, Rx HCC, CPT Category II, and Medicare Annual Wellness.
• Must have recent experience coding E/M and ICD-10-CM.
• Stay up to date on the hierarchies associated with both CMS and HHS defined HCCs as well as the ability to navigate between different models that are in place for defined audit initiatives.
• Extensive knowledge of medical terminology.
• Experience in researching and applying coding rules and regulations.
• Experience working in an audit software tool.
• Proficiency in Microsoft Excel, Word, and various EMR (Electronic Medical Record) systems.
• Strong attention to detail & excellent oral and written communication skills.
• Excellent time management and organizational skills.
• Have a positive, respectful attitude.

Benefits

• Medical, Dental, and Vision Insurance
• Phone and Internet Stipend
• Company-Paid Life Insurance
• 401(k) Retirement Plan with Company Match
• Paid Time Off
• Seven Company-Observed Holidays
• Two Floating Holidays for Personal Observance
• Professional Development Opportunities
• Employee Recognition Programs
• Remote Work Environment