HCC Coding Specialist - Exempt - Full Time - Days - Covina (on-site)

Emanate Health Foothill Presbyterian Hospital • Covina, CA

26d • Onsite

About The Position

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.

Requirements

• 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.
• 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.
• Certified Professional Coder (CPC), CRC, CCS, or equivalent certification required.

Nice To Haves

• Associate degree preferred.
• College degree preferred with coursework in Medical Terminology, Anatomy & Physiology.
• Experience working with EMRs, claims systems, and risk adjustment tools (e.g., Cozeva, Meditech, or similar platforms) preferred.

Responsibilities

• Oversight and execution of HCC and STAR Measures–related coding functions.
• Collaboration with IPA Director, Health Plan partners, MSO personnel, physicians, and billing staff.
• Ensuring accurate documentation, coding compliance, and optimal risk adjustment outcomes.
• Maintaining or exceeding the IPA’s Risk Adjustment Factor (RAF) of 1.0.
• Supporting the achievement or improvement of a 4.0 STAR Rating or higher.
• Provider education.
• Medical record review.
• Claims validation.
• Performance reporting for Medicare and Covered California lines of business.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree