1099 HCC Risk Adjustment & Professional-Fee (Physician) Auditor

Pinnacle Healthcare Consulting; United States; Remote; USD 55,000 - 83,000; Part time

Job summary

Pinnacle Enterprise Risk Consulting Services is seeking a REMOTE HCC Risk Adjustment and Professional-Fee (Physician) Reviewer / Auditor / Coder for as-needed, part-time hours on a 1099 basis. The role requires active coder certification and experience in Medicare risk adjustments, with a focus on accuracy and compliance.

The candidate will review records, abstract codes, and ensure payer guidelines are followed, while maintaining productivity in a remote setup.

Qualifications

• Active professional coding certification (CRC, CPC, CPMA or CCS) and current good standing with AHIMA or AAPC.
• Minimum four years as a certified coder/auditor in multi-specialty settings.
• Minimum two years in risk adjustment and provider evaluation and management (E/M).
• Ability to code ICD-10, modifiers, CPT/HCPCS.
• Strong computer proficiency including MS Office, Internet, and data portals.

Responsibilities

• Review medical records via PDF or EMR and assign CPT/HCPCS, ICD, and modifiers.
• Abstract and assign codes accurately.
• Research and resolve coding projects and document findings.
• Ensure legible documentation and valid signatures.
• Identify valid face-to-face encounters and analyze chart data for compliance.
• Meet daily production and quality goals (≈95% accuracy).
• Attend conference calls as needed.

Skills

Anatomy terminology

Medicare guidelines

Remote work discipline

Multi-tasking

Attention to detail

Communication skills

Analytical skills

Education

AHIMA/AAPC certification (CRC/CPC/CPMA/CCS)

High School diploma

College degree preferred

Tools

MS Windows

MS Office (Excel/Word)

Microsoft Access

Internet

Job description

1099 HCC Risk Adjustment & Professional-Fee (Physician) Coder

Remote- As needed / Hourly / Part-Time HCC Risk Adjustment and Professional-Fee Auditor 1099 hourly

Pinnacle Enterprise Risk Consulting Services

Full Job Description:

Pinnacle Enterprise Risk Consulting Services is actively looking to engage a REMOTE Risk Adjustment and Professional-Fee (Physician) Reviewer / Auditor / Coder for As Needed / Part-Time hours with a nationally recognized healthcare consulting company that is known for championing innovation, leading from the front with technology, and transforming the healthcare system.

What You Want to Know!

• 100% REMOTE - Work from home
• Flexible working schedule
• Holding at least one active AAPC or AHIMA certified program with the achievement of the correlating professional credential (RHIT, CPC, CCS, CPC-H etc.); in active and in good standing with the certifying organization. CPC, CPMA and CRC credentials preferred.
• High School diploma required. College degree preferred.
• Minimum of three (3) years of coding experience (recent hands-on production) in both areas. Must have at least one (1) year of specialized experience in Medicare Risk Adjustment

What Will You Be Doing:

The primary purpose of this position is to review documentation and assign the appropriate code(s) (CPT/HCPCS, ICD, Modifier).

Responsibilities:

• Review medical record via PDF or electronic medical record system
• Abstract and assign code(s) (CPT/HCPCS, ICD, Modifier)
• Research and resolution of coding projects assigned
• Document requested information from the medical record
• Determine valid encounters including legibility and valid signature requirements
• Identify valid face to face encounters
• Perform ongoing analysis of medical record charts for the appropriate coding compliance and validate against payor guidelines and client coding protocols.
• Coder is responsible for meeting daily production goal and quality goal of averaging 95% accuracy rate on a consistent basis
• Attend conference calls as necessary to provide information and/or feedback

Position Requirements:

• Active certified coder certification (CRC, CPC, CPMA, CCS - P) through AHIMA or AAPC
• Minimum four (4) years of experience as a certified coder/auditor in multi-specialties
• Minimum two (2) years of risk adjustment and provider evaluation and management (E/M) experience
• Ability to code ICD-10, modifier and CPT/HCPCS
• Computer proficiency (including MS Windows, MS Office, and the Internet)
• Knowledge of HIPAA, recognizing commitment to privacy, security, and confidentiality of all medical chart documentation
• Strong clinical knowledge related to chronic illness management, evaluation, assessment and treatment (MEAT)
• Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines (knowledge and demonstrated understanding of Risk Adjustment coding and data validation requirements is highly preferred)
• Reliability and a commitment to meeting tight deadlines
• Personal discipline to work remotely without direct supervision
• Exemplary attention to detail and completeness
• Strong organization, interpersonal, and customer service skills
• Written and oral communication skills
• Analytical skills

Skill Requirements:

Thorough knowledge of medical anatomy and terminology.. Understanding both the medical and business side of healthcare operations. Ability to read and understand Medicare / Medicaid and third-party payer guidelines. Professional, highly organized, self-motivated, detail-oriented, and energetic team player who can also work independently. Ability to multi-task in a fast-paced environment. Must be detail oriented. Strong computer skills including MS Office particularly Excel and Word, Internet, and E-mail, the ability to navigate internal network and external internet data portals required, Microsoft Access and Excel Intermediate to Advanced level skills preferred. Strong organization skills and an ability to work autonomously are required. Enjoys working in a team environment and participating in the development of departmental quality initiatives.

Excellent problem-solving ability and strong interpersonal skills and the ability to write clearly and succinctly in a variety of communication settings and styles. Ability to effectively communicate with multi-level personnel, medical professionals, clients, public and other representatives of the business. Excellent verbal and written communication skills. Self-starter with ability to learn quickly. Ability to successfully work on multiple projects/accounts simultaneously with frequent interruptions.