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 position helps ensure the IPA’s Risk Adjustment Factor (RAF) maintains or exceeds 1.0 and supports achieving or improving a 4.0 STAR rating or higher. It plays a key role in provider education, medical record review, claims validation, and performance reporting for Medicare and Covered California lines of business.
Emanate Health is a large nonprofit health care provider serving the San Gabriel Valley in California.
Education
- Associate degree preferred
- College degree preferred with coursework in Medical Terminology and Anatomy & Physiology
Experience
- Minimum 1 year of experience in a Medicare HCC program within an IPA, HMO, or clinic setting
- 2-5 years of coding experience using ICD-9, ICD-10, and CPT coding systems
- Experience with Medicare Advantage
- Experience interpreting medical records and claims data accurately
- Experience using EMRs, claims systems, and risk adjustment tools such as Cozeva, Meditech, or similar platforms preferred
Skills
- Strong knowledge of HCC risk adjustment methodology and STAR measures
- Proficiency in ICD-10-CM and CPT coding guidelines
- Excellent customer service skills
- Strong written and verbal communication skills
- Detail-oriented with strong analytical and organizational skills
- Proficiency in Microsoft Excel, PowerPoint, and Word, including data analysis, reporting, and presentation development
Certification
- CPC, CRC, CCS, or equivalent certification required
Location
California, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
3 weeks ago