HCC Coder

Candidates must have a primary address located within the state of Michigan or be willing to move to Michigan to be considered.

Travel to provider office location/offices for HCC education as determined by manager. Mandatory on-site team meetings in Midland once per month.

The HCC Coder works under the Clinical Documentation Integrity Manager to use coding expertise to identify opportunities impacting the quality and completeness of medical record documentation. The coder prospectively, concurrently, and retrospectively evaluates medical records to support the capture of Hierarchical Condition Categories (HCCs) and ICD-10-CM specificity of ambulatory visits. Collaboration with clinical team members is essential to capture chronic conditions affecting patient health status and predict future healthcare costs.

Key responsibilities include accurately processing HCC opportunities using claims and clinical data to facilitate provider HCC capture during patient encounters, maintaining quality and productivity standards, orienting and training providers on documentation HCC capture, educating medical staff on compliant HCC captures and RAF score optimization, providing education to clinical teams on software utilization for HCC capture, and sharing knowledge of risk adjusted payment methodologies, professional coding and billing, outpatient facility coding/billing, APC assignment, and OPPS reimbursement.

Additional duties include leading evaluation efforts for HCC documentation improvements, participating in meetings and department improvement activities, proactively communicating operational issues, and modeling professional standards of behavior.

Competency in Microsoft Windows is required.

Certification requirements include one of the following: Certified Professional Coder (CPC) or Certified Coding Specialist Physician Office (CCS-P). RHIT or RHIA preferred.

Education requirement: High school diploma or GED.

Experience preferred: Four years in the medical field, two years physician coding/billing, one year direct physician contact.

Strong interpersonal, written, and communication skills required. Effective educator, self-starter, highly organized, initiative and judgment required. Knowledge of medical terminology, anatomy, and Microsoft Word, Excel, PowerPoint preferred.

Physical requirements include ability to wear PPE, move about facility, sit/stand/walk for long periods, handle repetitive movements, occasional lifting of 0-10 lbs, exposure to blood borne pathogens with required compliance to safety protocols.