Responsible for the oversight and execution of HCC (Hierarchical Condition Category) and STAR Measures-related coding functions.
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.
Supports the IPA’s Risk Adjustment Factor (RAF) performance and contributes to achieving or improving a 4.0 STAR Rating or higher.
Plays a key role in provider education, medical record review, claims validation, and performance reporting for Medicare and Covered California lines of business.
Requirements & Qualifications
Education
- Associate degree preferred
- College degree preferred with coursework in Medical Terminology and Anatomy & Physiology
Experience
- Minimum of 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
- Ability to interpret medical records and claims data accurately
- Experience with EMRs, claims systems, and risk adjustment tools such as Cozeva or Meditech 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
- Experience using Microsoft Excel, PowerPoint, and Word for data analysis, reporting, and presentations
Certification
- Certified Professional Coder (CPC), CRC, CCS, or equivalent certification required
Location
California, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago