HEDIS Coding Specialist (Remote Option-NC)

Partners Behavioral Health Management • Gastonia, NC

96d

About The Position

The HEDIS Coding Specialist plays a critical role in ensuring accurate and compliant coding, documentation improvement, and adherence to National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements. With a background in medical coding and clinical practice, the specialist is responsible for reviewing medical records, identifying appropriate diagnosis codes, and ensuring documentation supports coding accuracy. Additionally, they collaborate with healthcare providers to address incomplete or missing clinical documentation, educate on proper coding practices, and facilitate training sessions as needed. By conducting audits, analyzing data, and communicating with internal and external stakeholders, the specialist helps improve coding accuracy, optimize revenue, and enhance the quality of care delivered to patients. Their meticulous attention to detail, strong analytical skills, and compliance expertise contribute to the organization's success in meeting HEDIS reporting requirements and achieving quality improvement goals.

Requirements

• Bachelor’s degree in health information management (HIM), Health Information Technology, Medical Coding, Nursing, or related healthcare field; OR Associate’s degree in health information management or medical Coding with minimum 3 years of medical coding experience.
• Minimum 2-3 years of experience in medical coding and documentation.
• Minimum 1 year of experience with HEDIS measures and reporting.
• Proficiency in ICD-10-CM/PCS, CPT, and HCPCS coding systems.
• Experience with coding software and audit tools.
• Advanced Excel skills for data analysis and reporting.
• Current certification from AHIMA (CCS, RHIA, RHIT) or AAPC (CPC, CRC).
• HEDIS certification or ability to obtain within 6 months of hire.

Nice To Haves

• Master’s degree in health information management or related field.
• 5+ years of medical coding experience.
• Previous experience in managed care or health plan environment.
• Experience with Epic, Cerner, or other major EHR systems.
• Knowledge of Medicare Advantage and Medicaid managed care operations.
• Knowledge of SQL or other database query languages preferred.

Responsibilities

• Conduct thorough reviews of medical records to ensure accurate coding and documentation in compliance with National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements.
• Identify opportunities for documentation improvement to support accurate coding and ensure alignment with coding guidelines and regulatory standards.
• Collaborate with healthcare providers to educate them on proper documentation practices, coding guidelines, and HEDIS measures.
• Perform audits to assess coding accuracy and completeness.
• Apply expertise in risk adjustment coding to accurately capture and report diagnosis codes relevant to Hierarchical Condition Categories, Risk Adjustment and Managed Care Contract reimbursement initiatives.
• Analyze coding and documentation data to identify trends, patterns, and opportunities for improvement.
• Ensure compliance with coding and documentation guidelines, regulatory requirements, and organizational standards.
• Serve as a resource for healthcare providers, offering guidance, feedback, and assistance with coding-related inquiries.
• Develop and deliver training sessions, workshops, or educational materials to healthcare providers and coding staff.
• Collaborate with cross-functional teams to support quality improvement initiatives.
• Generate reports and documentation to track coding accuracy, documentation improvement efforts, and compliance with HEDIS measures.
• Stay abreast of updates, changes, and advancements in coding guidelines, documentation standards, and regulatory requirements.

Benefits

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

What This Job Offers

• Education Level: Bachelor's degree