The HCC Lead Coder/Auditor performs advanced coding and audit reviews of outpatient medical records to validate the integrity of ICD-10 diagnoses and CPT-coded procedures. The role applies deep knowledge of coding guidelines, risk adjustment methodologies, and regulatory requirements to support accuracy, compliance, and optimal reimbursement.
This position includes direct client interaction, requiring clear communication of audit findings, recommendations, and documentation improvement opportunities. In addition to core coding and auditing responsibilities, the role analyzes coding trends, contributes to quality improvement initiatives, and supports client engagements with a high degree of autonomy.
Responsibilities
- Design and deliver targeted coding education based on audit findings, regulatory updates, and client needs.
- Develop training materials, presentations, and reference guides for internal teams and client stakeholders.
- Translate complex coding guidelines, audit results, and regulatory requirements into clear, actionable guidance.
- Lead efforts to improve clinical documentation practices in alignment with risk adjustment requirements.
- Support client readiness for RADV and/or HRADV audits by identifying risks and providing mitigation guidance.
- Serve as a subject matter expert in ICD-10 coding and risk adjustment models such as CMS-HCC and/or HHS-HCC.
- Provide expert consultation on complex coding scenarios and documentation challenges.
- Monitor regulatory and industry changes and communicate impacts to internal teams and clients.
- Influence coding and documentation practices through education, consultation, and stakeholder engagement.
- Partner with leadership to identify opportunities to enhance coding accuracy, documentation integrity, and client outcomes.
- Collaborate with internal teams and external partners to improve coding tools, workflows, and emerging technologies.
Qualifications
- High school diploma required; associate's or bachelor's degree preferred.
- Current AHIMA or AAPC certification required, such as CPC, CCS-P, RHIA, RHIT, or CPMA.
- Certified Risk Adjustment Coder (CRC) certification required.
- Minimum of 5 years of experience in medical coding and/or auditing.
- Strongly preferred: experience with CMS-HCC and/or HHS-HCC risk adjustment models.
- Preferred: experience supporting or participating in RADV and/or HRADV audits.
- Advanced knowledge of ICD-10 coding guidelines, medical terminology, and reimbursement methodologies.
- Strong analytical skills with the ability to identify trends and provide actionable recommendations.
- Ability to interpret complex medical records and apply appropriate coding standards.
- Strong written and verbal communication skills, including the ability to present findings to clients.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
- Proficiency in Microsoft Office and coding/audit systems.
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
3 weeks ago