HCC Coder
The Judge Group
Software Engineering
Remote
Medical Risk Adjustment Coder (Remote)
Location: Remote (Must reside within the Continental United States)
Position Type: Full-Time, 40 hours per week
Schedule: Monday – Friday, 8-hour daytime schedule tailored to your local time zone
Training Hours: Monday – Friday, 8:00 AM – 5:00 PM ET (Attendance is mandatory)
MUST HAVE HUMANA EXPERIENCE
Position Overview
This home-based position is designed for a detail-oriented, certified medical coder responsible for reviewing medical records to ensure accurate, compliant, and complete diagnosis code abstraction. Aligned with strict productivity and quality requirements, this role focuses on Medicare, Commercial, and Medicaid risk adjustment across various chart types (physician, facility, and non-facility). The successful candidate will thrive in a fast-paced environment, maintaining high quality while executing general coding workflows and specialized review projects.
Key Responsibilities
Code Abstraction & Quality Assurance
Diagnosis Code Abstraction: Review diverse medical record types to ensure accurate, compliant, and complete diagnosis code abstraction for hierarchical condition category (HCC) risk adjustment.
Guideline Adherence: Code strictly in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, AHA’s Coding Clinic, as well as Cotiviti and client-specific coding policies.
Performance Standards: Consistently achieve and exceed the department benchmark of 95% quality accuracy and met production expectations.
Special Projects: Participate in full comprehensive coding reviews and specialized data-validation projects as assigned.
Communication & Continuous Improvement
Operational Reporting: Proactively communicate with management, Team Leads, and corporate partners regarding workload volumes, production deliverables, and timeline milestones.
Dispute Resolution: Utilize established 'Dispute Resolution' channels to professionally address and clarify conflicting coding determinations.
Professional Development: Stay current on evolving regulatory coding guidelines by actively participating in all required trainings, workshops, and independent research.
Qualifications
Required Certifications & Education
Certification: Must hold an active national coding certification in good standing through AAPC or AHIMA (e.g., CRC, CPC, CCS).
Education: Minimum of a High School Diploma or GED.
Experience & Technical Skills
Experience: 1–2 years of direct experience in medical risk adjustment / HCC coding, specifically including hands-on experience in HCC record abstraction.
Clinical Knowledge: Strong, demonstrated mastery of medical terminology, anatomy, and physiology.
Technical Aptitude: Intermediate computer literacy with the ability to navigate dedicated electronic coding platforms while maintaining a focus on speed and data integrity.
Remote Work Requirements
Must have a dedicated, secure home office space free from external noise and distractions.
Must possess and maintain a reliable, high-speed internet connection.
Absolute adherence to all HIPAA regulations and patient data confidentiality standards.
Core Competencies
Adaptability: A quick learner with a positive attitude who can manage tight deadlines and adapt seamlessly to changing priorities.
Communication: Exceptional written and verbal communication skills, with a proven ability to distill and explain complex clinical or technical data.
Time Management: Highly organized individual capable of working independently under minimal supervision in a fast-paced production environment.
Physical & Mental Requirements
Stationary Work: Remaining in a stationary position, sitting or standing, for prolonged periods of time to perform digital coding functions.
Repetitive Motion: Repeating motions that frequently include the wrists, hands, and/or fingers for typing and system navigation.
Cognitive Demand: Ability to rapidly process complex medical documentation, evaluate competing compliance protocols, and synthesize data to meet strict quality thresholds.