HCC Coder

PedIM Healthcare•Lecanto, FL

About The Position

Join the Team at PedIM Healthcare! Delivering exceptional care, together. Who We Are PedIM Healthcare is the first private medical office of its kind in Citrus County – offering top-quality care for children, adults, and seniors all under one roof. We provide pediatric, adult internal medicine, family practice, geriatrics, women’s care, medical weight-loss, sleep-medicine services and more. Our dedicated, community-focused team is committed to excellence, pride in service, and making a real difference for patients and families across Citrus County. Why Work With Us? A broad, multi-discipline practice where you can grow: pediatrics, internal medicine, weight-loss & sleep medicine specialties. A values-driven environment: we listen, we help, we understand—and we care. Community-oriented and recognized: voted “best of the best” in the region. Opportunity to make a meaningful impact by supporting patients over their full life span—from children to seniors. A workplace committed to employee development and delivering holistic care. The Role We are seeking a proactive and compassionate HCC Coder to join our Primary Care team! This role is critical to ensuring accurate risk adjustment, complete documentation, and compliance with CMS guidelines while supporting high-quality patient outcomes. You will be responsible for reviewing medical records, identifying appropriate HCC diagnoses, ensuring documentation integrity, and collaborating closely with providers and clinical teams to optimize RAF scores and coding accuracy.

Requirements

Minimum 2+ years of HCC/Risk Adjustment coding experience (required)
Strong knowledge of CMS risk adjustment methodology and Medicare Advantage models
Proven experience with chart audits and provider education
Experience with EHR systems required

Nice To Haves

Active coding credential preferred (CRC, CPC, CCS, or equivalent)
Experience performing pre and post -visit RAF reviews preferred
Value-based care experience strongly preferred

Responsibilities

Conduct pre-visit and chart reviews to identify known and suspected RAF/HCC conditions prior to patient appointments
Conduct post-visit chart reviews to ensure all RAF/HCC opportunities have been captured by the medical provider prior to claims submission/billing
Conduct post claims submission reconciliation from payer to ensure all codes have been properly accounted for through files such as MOA004, MOR and MMR
Review provider documentation and assign accurate ICD-10 and HCC codes
Identify documentation gaps and provide clear, actionable feedback to providers
Track coding trends and identify performance improvement opportunities
Collaborate closely with Clinical Integrity, Outreach, and Provider Teams
Maintain established productivity and quality benchmarks
Stay current with CMS risk adjustment guidelines and regulatory updates