HCC & ProFee Coder

Dahl Consulting; California (MO); Hybrid; USD 39,000 - 44,000; Part time

Benefits offered by this job

Medical, dental, and vision insurance

401(k) with company match

Phone and internet stipend

Remote work environment

Job summary

Dahl Consulting is seeking an experienced HCC & ProFee Coder for a remote contract-to-hire opportunity in the Hospital & Healthcare sector. The role demands expertise in CMS HCC, Rx HCC, ICD-10-CM, and Medicare coding guidelines to validate records and support risk adjustment initiatives.

The candidate will review medical records, ensure coding compliance, and collaborate with providers and project leadership. AAPC/AHIMA credentials and 5+ years of HCC coding experience are preferred.

Qualifications

• Current AAPC or AHIMA credential (CPC/COC/CCS-P).
• Minimum 5 years of HCC-specific coding experience.
• Extensive experience with ICD-10-CM, CMS HCC risk adjustment, Rx HCC, CPT Category II coding, and Medicare AWV coding.
• Strong knowledge of CMS/HHS HCC hierarchies and risk adjustment models.
• Experience with coding audit software and EMR systems.

Responsibilities

• Review and validate diagnosis codes to ensure documentation supports coding and guidelines.
• Verify coding accuracy per project requirements and documentation.
• Perform CMS HCC risk adjustment code validation and data abstraction review.
• Perform Rx HCC risk adjustment code validation and data abstraction review.
• Review CPT Category II codes and supporting documentation for accuracy.
• Document time worked and complete administrative tasks with accuracy.

Skills

HCC coding

CPC/COC/CCS-P

Auditing

Excel

EMR systems

Communication

Education

AAPC or AHIMA credential

Tools

EMR systems

Excel

Word

Job description

Title

HCC & ProFee Coder

Location

Remote

Job Type

Contract to Hire

Compensation

$30.00 per hour (W2)

Industry

Hospital & Healthcare

About the Role

Our firm is recruiting on behalf of a healthcare services client that supports health plans, provider organizations, and value-based care initiatives through advanced coding, risk adjustment, and documentation review services. We are seeking an experienced HCC & ProFee Coder to perform high-level coding validation, risk adjustment auditing, and clinical documentation review activities. This role is ideal for a coding professional with deep expertise in CMS HCC, Rx HCC, ICD-10-CM, and Medicare coding guidelines who thrives in a detail-oriented, quality-focused environment.

Job Description

The HCC & ProFee Coder is responsible for reviewing medical records to validate coding accuracy, ensure compliance with regulatory guidelines, and support risk adjustment and quality improvement initiatives. The position requires extensive knowledge of ICD-10-CM coding, HCC methodologies, provider documentation standards, and coding compliance requirements.

Key Responsibilities

• Review and validate diagnosis codes to ensure they are supported by clinical documentation and compliant with ICD-10-CM Official Coding Guidelines.
• Verify coding accuracy in accordance with project-specific coding and documentation requirements.
• Perform CMS HCC risk adjustment code validation and data abstraction review.
• Perform Rx HCC risk adjustment code validation and data abstraction review.
• Review CPT Category II coding and supporting documentation for accuracy and completeness.
• Apply Medicare Annual Wellness Visit coding and documentation guidelines.
• Enter coding and audit data accurately into client systems and reporting tools.
• Evaluate provider documentation quality and identify opportunities for clinical documentation improvement.
• Communicate with providers as needed to obtain coding clarification or missing documentation.
• Maintain a minimum coding accuracy rate of 96% and successfully meet quality standards during onboarding and ongoing audits.
• Collaborate with project leadership regarding assignments, workload management, schedule updates, and coding-related questions.
• Accurately document time worked and complete required administrative tasks.
• Ensure compliance with HIPAA, protected health information (PHI) requirements, and all applicable privacy regulations.
• Adhere to federal and state regulations, coding standards, and industry best practices.
• Perform additional duties as assigned.

Qualifications Required

Current AAPC or AHIMA credential, including one of the following: CPC (Certified Professional Coder) COC (Certified Outpatient Coder) CCS-P (Certified Coding Specialist - Physician-Based)

Minimum 5 years of HCC-specific coding experience.

• Extensive experience with:
• ICD-10-CM coding
• CMS HCC risk adjustment
• Rx HCC risk adjustment
• CPT Category II coding
• Medicare Annual Wellness Visit coding
• Recent professional experience coding E/M services and ICD-10-CM diagnoses.
• Strong understanding of CMS and HHS HCC hierarchies and risk adjustment models.
• Advanced knowledge of medical terminology, anatomy, and clinical documentation requirements.
• Experience researching and applying coding regulations, guidelines, and compliance standards.
• Experience using coding audit and review software.
• Proficiency with Microsoft Excel, Word, and electronic medical record (EMR) systems.
• Exceptional attention to detail with strong written and verbal communication skills.
• Excellent organizational, time management, and prioritization abilities.
• Ability to work independently while maintaining high productivity and accuracy standards.
• Professional, positive, and collaborative approach to work.
• Preferred CRC (Certified Risk Adjustment Coder) credential.
• Additional experience in risk adjustment auditing, provider education, and documentation improvement initiatives.
• Experience supporting quality improvement or value-based care programs.
• Multi-specialty physician coding experience.
• Familiarity with a variety of EMR platforms and healthcare technology tools.

Benefits

• Our partner offers a comprehensive benefits package for full-time team members, including medical, dental, and vision insurance; company-paid life insurance; and a 401(k) retirement plan with company match.
• Employees also receive a phone and internet stipend, generous paid time off, seven company-observed holidays, and two floating holidays for personal observance.
• Additional perks include professional development opportunities, employee recognition programs, and the flexibility of a remote work environment designed to support work-life balance.

Equal Opportunity Statement

As an equal opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you!