HEALTH CODER - HCC & RISK ADJUSTMENT

NORTH EAST MEDICAL SERVICES; Burlingame (CA); On-site; USD 58,947 - 67,158; Full time

Job summary

NORTH EAST MEDICAL SERVICES is seeking a full-time medical coder in Burlingame, CA. The role involves reviewing patient charts, ensuring coding accuracy, developing training materials, and maintaining compliance with CMS guidelines.

Ideal candidates will possess a BS/BA degree, certification in medical coding, and at least 3 years of related experience, including expertise in ICD-10-CM coding. Knowledge of EHR systems is essential.

Qualifications

• Minimum of 3 years of experience in medical coding with a focus on HCC, risk adjustment, and Medicare Advantage programs.
• Experience in provider education, clinical documentation improvement (CDI), and chart audits.
• Fluency in other languages is an asset.

Responsibilities

• Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines.
• Develop and deliver provider education sessions on best practices for clinical documentation and HCC/RA coding.
• Analyze coding data to identify trends, documentation gaps, and opportunities for improvement.

Skills

Communication Skills

Presentation Skills

Interpersonal Skills

Analytical Skills

Problem-Solving Skills

Knowledge of ICD-10-CM Coding

Proficiency in EHR

Education

BS/BA Degree in Health Science or General Education

Certified Professional Coder (CPC)

Certified Risk Adjustment Coder (CRC)

Job description

Job Details

Job Location: Burlingame, CA 94010
Salary Range: $42.79 - $48.75 Hourly

ESSENTIAL JOB FUNCTIONS

HCC Coding and Risk Adjustment (RA) Program Support

• Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines.
• Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance.
• Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy.

Provider Training and Clinical Documentation Improvement (CDI)

• Develop and deliver provider education sessions and materials on best practices for clinical documentation and HCC/RA coding.
• Provide one‑on‑one and group training to providers and clinical staff to improve documentation quality and accuracy.
• Serve as a resource and subject matter expert on HCC, risk adjustment, and related coding standards.

Data Analysis and Reporting

• Analyze coding data to identify trends, documentation gaps, and opportunities for improvement.
• Generate reports and dashboards to track coding performance and documentation accuracy.
• Collaborate with the Quality and Analytics teams to optimize risk adjustment processes.

Compliance and Continuous Improvement

• Stay up‑to‑date with changes in coding, risk adjustment, and Medicare regulations.
• Assist in the development and implementation of internal coding policies and procedures.
• Participate in quality improvement initiatives related to coding and documentation.
• Perform other job duties as required by manager/supervisor.

Education & Certification

• BS/BA Degree in Health Science or General Education is required.
• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification is required.
• Additional CDI or auditing certifications (CCDS, CDEO, CPMA) are preferred.

Experience

• Minimum of 3 years of experience in medical coding with a focus on HCC, risk adjustment, and Medicare Advantage programs.
• Experience in provider education, clinical documentation improvement (CDI), and chart audits.
• Previous experience working in an IPA, managed care organization, or similar setting is strongly preferred.

Skills & Competencies

• Excellent communication, presentation, and interpersonal skills.
• Strong understanding of CMS guidelines for Medicare Advantage and risk adjustment program.
• Exceptional knowledge of ICD-10-CM coding and HCC risk adjustment coding methodologies.
• Proficiency in electronic health records (EHR) and coding software.
• Strong analytical and problem‑solving skills.

Language

• Must be able to fluently speak, read and write English.
• Fluency in other languages is an asset.

Status

This is an FLSA Non‑exempt position.

This is not an OSHA high‑risk position.

This a full‑time position.