HCC Coding Specialist

The coding specialist reviews medical records and accurately codes the diagnoses using ICD-10 CM/CPT coding conventions. The candidate must review and abstract HCC codes to ensure they are coded accurately, to the highest specificity possible, and make sure the required MEAT is documented. The coding specialist coordinates with others to ensure that referral and billing information is accurate and timely to maximize reimbursements and minimize unrealized revenue.

In this position you will:

  • Review/abstract HCC codes to ensure they are coded accurately, to the highest specificity possible, and make sure the required MEAT is documented, resulting in the correct CMS-HCC risk score
  • Work all Medicare Annual Wellness Visits (100% review) to ensure the correct code is being billed, including adding appropriate codes for Chronic Condition Review, and or E&M/Procedure codes
  • Perform 100% chart review of assigned providers, including CPT/HCPS Codes (this also includes procedures, medications, vaccines, etc.), Diagnosis, Place of Service, Providers (service and billing), Dates of Service, provide feedback to providers when the level of service is not supported, or documentation is unclear
  • Work/clear all coding edits in our assigned clinics to support a clean claim
  • Enter all missing charges into eClinicalWorks EHR, with careful attention to adding notes to clarify clinic charges
  • Read and interpret all documents contained in the medical record to identify all diagnoses and procedures
  • Perform coding audits and review of outpatient provider services to support coding optimization and compliance for the health system
  • In addition to the audit and review work, the Coder will work side by side with providers providing ongoing feedback, coaching, and support with the code entry process, documentation, ICD-10, and HCC coding in alignment with current health system reimbursement requirements.
  • Refers questions and coding issues to a senior level.
  • Performs chart audits to ensure documentation supports coding.
  • Maintains confidentiality of records, patient, employee, or health system information at all times. Ensures all information and conversations regarding patients are secured from public access. Complies with HIPAA guidelines.
  • Attends all mandatory in-services and organizational meetings.
  • Participates in meetings, committees, and task forces within the organization in order to improve systems, communication, and operations.
  • Other duties as assigned



Required qualifications for this position include:

  • Accredited program for medical coding.
  • Candidate must have a certificate in coding: CPC, CCS-P, and/or CMC or obtain it within one year of hire at their own expense.
  • Utilizes established manual and automated systems and procedures to track coding discrepancies.

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