HCC Coding Specialist (Office Based)

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  • 20-00048
  • Full Time/Contract
  • Recruiting
  • Rancho Cucamonga, CA
Job Description
HCC Coding Specialist

The HCC Coding Specialist will perform on-going chart review projects and activities assigned by the HCC Subcommittee and Director of Quality Informatics in an effort to improve Company's HCC/RAPS reporting to CMS. This position is responsible for collecting, reviewing, validating, and submitting pertinent HCC diagnostic data from both internal and external sources. The HCC Coder will collect information related to HCC reconciliation and assists in the Company's efforts aimed to maximize medical record documentation standards, coding standards, and Member care. This position will develop measurement tools to report effectiveness of HCC reviews at the Provider level. Assist in identifying potential coding patterns and areas needed for provider educational outreach.

  • Performs ongoing HCC-related improvement projects assigned by the HCC subcommittee or Clinical Informatics Manager in an effort to compile accurate and complete ICD-10 physician coding and maximize the Company's HCC result.
  • Conducts clinical chart reviews, perform audits, and on-site reviews using prioritized HCC target lists.
  • Analyzes the Company's claim and encounter data to identify incomplete or inaccurate ICD-10 coding patterns submitted at the physician level. Use this data to develop targeted educational outreach to physician offices.
  • Works closely with the HCC Subcommittee in identifying opportunities for HCC coding education and business strategies within the Company's Provider Network
  • Develops educational coding materials for use in provider education outreach activities.
  • Develops measurement tools to assess HCC data adequacy and identifying deficient coding patterns and provider educational needs.
  • Conducts provider training sessions related to proper HCC coding practices.
  • Demonstrate a commitment to incorporate LEAN principles into daily work.
  • Any other duties as required to ensure that Health Plan operations are successful.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in the Company's policies and procedures relating to HIPAA compliance.


  • Possession of a high school degree or equivalent.
  • AHIMA or AAPC Certified Coder with experience in managed care, program/project management, data analysis & interpretation.
  • RN or LVN with current California license preferred.
  • Two (2) years of experience in HCC Coding in an HMO Setting preferred.
  • Strong chart audit experience in HCC coding.
  • Working knowledge of Centers for Medicare & Medicaid Services (CMS) HCC coding requirements, ICD-10 and CPT guidelines are required.
  • Knowledge in HCC-Risk Adjustment process and health insurance concepts as they relate to Medicare Advantage and Part D plans is required.
  • Ability to take general direction and manage complex projects within deadlines.
  • Excellent written, oral, and presentation skills.
  • Proficiency in Microsoft Word, Excel, and other computer applications.
  • Ability to organize and prioritize and attention to detail.
  • Driver's License and Valid Insurance.


  • $29.62/hr
  • Benefited | Full-Time | Non-Exempt


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