HCC Coder

PedIM Healthcare•Lecanto, FL

5d•Remote

About The Position

PedIM Healthcare is seeking an experienced HCC Coder to join our growing value-based care team. This role is critical to ensuring accurate risk adjustment, complete documentation, and compliance with CMS guidelines while supporting high-quality patient outcomes. The HCC Coder 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
Active coding credential preferred (CRC, CPC, CCS, or equivalent)
Proven experience with chart audits and provider education
Experience performing pre and post -visit RAF reviews preferred
Strong analytical skills and attention to detail
Experience with EHR systems required
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