HCC Medical Coder

HCC Medical Coder Job Description

Job Overview:

An HCC (Hierarchical Condition Category) Medical Coder is responsible for reviewing medical records and assigning appropriate ICD-10-CM diagnosis codes to ensure accurate risk adjustment and reimbursement. HCC coders work primarily with Medicare Advantage, ACA (Affordable Care Act), and other risk-adjusted health plans to capture chronic conditions and disease complexity.

Key Responsibilities:

• Review and Analyze Medical Records
  
• Examine physician documentation for completeness and accuracy.
• Identify chronic conditions and assign appropriate HCC diagnosis codes.
• Ensure documentation supports the assigned codes for risk adjustment purposes.
• Apply ICD-10-CM Coding Guidelines
  
• Assign correct and specific diagnosis codes based on CMS (Centers for Medicare & Medicaid Services) HCC guidelines.
• Follow official coding policies, including AHA, AHIMA, and CMS regulations.
• Ensure Compliance & Accuracy
  
• Adhere to federal, state, and payer-specific regulations.
• Maintain accuracy benchmarks (typically 95% or higher) and productivity standards.
• Participate in internal and external audits to validate coding accuracy.
• Collaborate with Healthcare Teams
  
• Work with physicians and clinical staff to clarify documentation.
• Educate providers on best practices for complete and specific documentation.
• Stay Updated on Coding Changes
  
• Monitor CMS and HHS (Health and Human Services) updates related to HCC coding.
• Participate in continuing education and certification renewals.

Required Qualifications:

• Education:
  
• High school diploma or equivalent required.
• Associates or Bachelors degree in health information management, medical coding, or a related field preferred.
• Certifications (One or More Required):
  
• Certified Risk Adjustment Coder (CRC) – AAPC
• Certified Professional Coder (CPC) – AAPC
• Certified Coding Specialist (CCS) – AHIMA
• Experience:
  
• Minimum 1-3 years of HCC or risk adjustment coding experience preferred.
• Strong knowledge of ICD-10-CM coding, CMS risk adjustment models, and medical terminology.
• Skills:
  
• Proficiency in coding software (e.g., Optum, 3M, EPIC, or similar).
• Excellent attention to detail and analytical skills.
• Ability to work independently and meet productivity standards.