Remote Medicare HCC Coding Analyst CRC Certified

Praxy; Northern (KY); Remote; USD 59,000 - 88,000; Full time

Job summary

Alignment Health is seeking a Medicare HCC Coding Analyst to oversee coding quality and risk adjustment initiatives across the provider network. You will audit submissions, educate clinicians on CMS-HCC models, and coordinate with CMS data validation activities.

The role requires a certified coder with 3+ years in medical coding, experience in risk adjustment, and proficiency with Epic, Allscripts or EZCap; remote work option available in the U.S.

Qualifications

• Professional coding experience in a medical group or health plan setting.
• Minimum 3+ years of coding experience; 1 year in risk adjustment planning preferred.
• Experience with CMS HCC models and data validation.
• Licensed/certified coder required; CCS, CCS-P, CPC are a plus.

Responsibilities

• Monitor coding and abstracting quality through audits and performance improvement.
• Develop and refine IPA educational tools for providers to improve condition capture.
• Track audits on coding vendors to ensure CMS data accuracy.
• Collaborate with Risk Adjustment Management on data validation and RADV audits.
• Maintain tracking systems for assigned IPA networks and risk adjustment activities.
• Correlate risk adjustment activities with outcomes and metrics.
• Ensure compliance with federal, state, and local regulations and organizational standards.
• Support training activities for Risk Adjustment teams and maintain training records.
• Suggest new risk adjustment coding initiatives and participate in SCITs/education meetings.
• Coordinate risk adjustment audit activities and assist with CMS data validation tasks.
• Update risk adjustment materials for CMS guidelines and ICD-9/ICD-10 changes.
• Maintain knowledge of industry coding, compliance, and HCC issues.

Skills

Effective communication

Leadership and collaboration

Problem solving

Analytical reasoning

Report analysis

Mathematical calculations

Education

High School Diploma or GED

Tools

Epic

Allscripts

EZCap

Athena EHR

Job description

Alignment Health is seeking a Medicare HCC Coding Analyst to oversee coding quality and risk adjustment initiatives across the provider network. You will audit submissions, educate clinicians on CMS-HCC models, and coordinate with CMS data validation activities.

The role requires a certified coder with 3+ years in medical coding, experience in risk adjustment, and proficiency with Epic, Allscripts or EZCap; remote work option available in the U.S.