HCC Quality Assurance Coder/Auditor (Remote)

Pride Health; Arizona; Hybrid; USD 130,872,000 - 135,005,000; Full time

Benefits offered by this job

Healthcare coverage

401(k) plan

Employee discounts

Job summary

Pride Global is hiring a Quality Assurance Coder/Auditor to support risk adjustment, HCC coding quality, auditing, and provider education initiatives. You will review medical records and ensure accurate ICD-10 coding per CMS and Medicare Managed Care guidelines.

The role conducts QA audits of provider/vendor data, identifies documentation gaps, and develops training materials for providers and coding staff. Strong knowledge of HCC methodologies is required.

Qualifications

• At least 5 years of professional medical coding experience.
• At least 3 years of HCC/risk adjustment coding experience.
• At least 2 years of HCC auditing or quality assurance experience.
• Advanced knowledge of ICD-10 coding guidelines and HCC methodologies.
• Experience reviewing and auditing medical records and clinical documentation.
• Strong written and verbal communication; able to develop training materials.
• Proficiency with Word, Excel, and PowerPoint.
• High School Diploma or GED.

Responsibilities

• Review and audit medical records for coding accuracy.
• Perform HCC coding and risk adjustment QA audits.
• Validate diagnosis codes with proper documentation and encounters.
• Identify coding errors, documentation gaps, and risk mitigation opportunities.
• Conduct QA audits of vendor data and provide corrective actions.
• Track audit findings and prepare monthly reports for management.
• Develop and deliver training materials for providers and coders.
• Prepare educational materials and PowerPoint presentations.
• Maintain knowledge of ICD-10, CMS risk adjustment rules and regulations.
• Address encounter rejections and support resolution in vendor platforms.

Skills

Medical coding

HCC/risk adjustment

Auditing

Documentation review

Training materials development

PowerPoint presentations

Verbal communication

Education

CPC – Certified Professional Coder

High School Diploma or GED

Tools

MS Word

MS Excel

PowerPoint

Job description

Pride Global is hiring a Quality Assurance Coder/Auditor to support risk adjustment, HCC coding quality, auditing, and provider education initiatives. You will review medical records and ensure accurate ICD-10 coding per CMS and Medicare Managed Care guidelines.

The role conducts QA audits of provider/vendor data, identifies documentation gaps, and develops training materials for providers and coding staff. Strong knowledge of HCC methodologies is required.