Medical Coder

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

• Job Title: Quality Assurance Coder/Auditor
• Location: Hybrid (1 - Day in office) / (Can be Fully remote for Arizona's candidate)
• Schedule: Full-Time | Monday – Friday | 8:00 AM – 5:00 PM ET
• Vacancy Type: FTC - 6 months with Option to Extend or Convert to Permanent
• Pay Rate: $46.07 per hour without benefits

Job Summary

We are seeking an experienced Quality Assurance Coder/Auditor to support risk adjustment, HCC coding quality, auditing, and provider education initiatives. This individual will review medical records and supporting documentation to ensure accurate, complete, and compliant diagnosis coding in accordance with ICD-10, CMS, Medicare Managed Care, and risk adjustment guidelines.

The Coder/Auditor will perform quality audits of provider and vendor-submitted HCC data, identify coding and documentation deficiencies, recommend corrective actions, and develop educational materials for providers and coding staff. This role requires strong knowledge of HCC coding methodologies, risk adjustment models, coding guidelines, and medical record documentation requirements.

Key Responsibilities

• Review and audit medical records, diagnoses, and supporting documentation for coding accuracy and completeness.
• Perform HCC coding and risk adjustment quality assurance audits.
• Validate diagnosis codes and ensure coding is supported by appropriate face-to-face encounters and valid documentation.
• Identify coding errors, unsupported diagnoses, documentation gaps, and risk mitigation opportunities.
• Conduct QA audits of vendor and supplemental HCC data submissions and provide corrective action recommendations.
• Track audit findings and prepare monthly reports and updates for management and vendor teams.
• Develop and deliver provider and coder education related to coding accuracy, documentation improvement, and healthcare gap closure.
• Prepare educational materials, written communications, and PowerPoint presentations.
• Maintain current knowledge of ICD-10, CMS risk adjustment methodologies, Medicare Managed Care Manual Chapter 7, and related regulations.
• Correct encounter rejections and support resolution of coding-related issues within vendor platforms.

Required Qualifications

• Minimum 5 years of professional medical coding experience.
• Minimum 3 years of HCC/risk adjustment coding experience.
• Minimum 2 years of HCC auditing or quality assurance experience.
• Advanced knowledge of ICD-10 coding guidelines and HCC methodologies.
• Strong understanding of CMS risk adjustment models and ICD-to-HCC crosswalks.
• Knowledge of Medicare Managed Care and Chapter 7 – Risk Adjustment requirements.
• Experience reviewing and auditing medical records and clinical documentation.
• Strong written and verbal communication skills.
• Experience developing training materials and educating providers or coding teams.
• Ability to prepare and present PowerPoint presentations.
• Proficiency with Microsoft Word, Excel, and PowerPoint.
• High School Diploma or GED.

Required Certification

Candidates must hold at least one of the following certifications:

• CPC – Certified Professional Coder

Preferred Qualifications

• Knowledge of RADV (Risk Adjustment Data Validation) processes.
• Pharmacology knowledge.
• Experience with Medicare Advantage or managed care populations.

Pride Global and its affiliates offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.

Pride Global and its affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Pride Global and its affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation