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Job Summary
The HCC Coding Specialist is responsible for the oversight and execution of HCC (Hierarchical Condition Category) and STAR Measures-related coding functions. This role collaborates closely with the IPA Director, Health Plan partners, MSO personnel, physicians, and billing staff to ensure accurate documentation, coding compliance, and optimal risk adjustment outcomes.
The HCC Coding Specialist ensures the IPA's Risk Adjustment Factor (RAF) maintains or exceeds 1.0 and supports achieving or improving a 4.0 STAR Rating or higher. This position plays a critical role in provider education, medical record review, claims validation, and performance reporting for Medicare and Covered California lines of business.
Job Requirements
Minimum Education Requirement :
Associate degree preferred; college degree preferred with coursework in Medical Terminology, Anatomy & Physiology.
Minimum Experience Requirement :
Minimum of one (1) year experience in Medicare HCC program within IPA, HMO, or clinic setting. Two to five (2-5) years of coding experience using ICD-9, ICD-10 and CPT coding systems. Excellent customer service skills required. Strong knowledge of HCC risk adjustment methodology and STAR measures. Proficiency in ICD-10-CM and CPT coding guidelines. Required experience using Microsoft Excel, PowerPoint, and Word, including data analysis, reporting, and presentation development. Experience working with Medicare Advantage. Ability to interpret medical records and claims data accurately. Strong written and verbal communication skills.
Detail-oriented with strong analytical and organizational skills. Experience working with EMRs, claims systems, and risk adjustment tools (e.g., Cozeva, Meditech, or similar platforms) preferred.
Minimum License Requirement :
Certified Professional Coder (CPC), CRC, CCS, or equivalent certification required.
Pay Range:
$34.50 - $51.31
