Senior HCC Coding & Risk-Adjustment QA Auditor

Wollborg Michelson Recruiting; Phoenix (AZ); On-site; USD 65,000 - 85,000; Full time

Job summary

Wollborg Michelson Recruiting is seeking an experienced medical coder and auditor to support risk mitigation and provider education around HCC coding and risk adjustment. This role focuses on reviewing medical records, identifying inappropriate or unsupported diagnoses, and guiding compliant documentation.

You will educate providers, perform QA audits, validate face-to-face encounters, and stay aligned with Medicare Managed Care requirements.

Qualifications

• At least five years of professional coding experience, including three years of HCC coding and two years of HCC auditing.
• Advanced knowledge of coding guidelines.
• High school diploma or GED.
• One of CCS-P, CRC, CPC, or COC certifications.

Responsibilities

• Educate primary care providers on historical diagnosis and coding trends, medical record documentation, at-risk codes, and risk mitigation.
• Review medical records and supporting documentation to determine completeness, accuracy, and appropriate coding.
• Identify documentation barriers and recommend coding improvements and best practices.
• Validate encounters, including face-to-face requirements, legibility, valid signatures, and Medicare Managed Care requirements.
• Perform quality assurance audits of vendor and provider group supplemental data submissions.
• Provide corrective action recommendations when accuracy scores fall below 95%.
• Track quality assurance audits and provide management updates regarding findings, healthcare gaps, documentation, coding, and education needs.
• Develop provider and coder education programs, training materials, and educational content.
• Prepare and deliver educational presentations through virtual meetings.
• Correct encounter rejections within vendor platforms.
• Maintain current knowledge of Medicare Managed Care risk adjustment requirements and outpatient billing processes.
• Maintain required coding certifications and stay informed about changes in risk adjustment methodologies.
• Perform other duties as assigned.

Skills

HCC coding rules

CMS crosswalk

ICD-10 guidelines

Medicare risk adjustment

Communication skills

Training materials

Documentation deficiencies

Microsoft Office

Provider education

Healthcare billing knowledge

Education

CCS-P

CRC

CPC

COC

High school diploma or GED

Tools

Excel

PowerPoint

Word

Job description

Wollborg Michelson Recruiting is seeking an experienced medical coder and auditor to support risk mitigation and provider education around HCC coding and risk adjustment. This role focuses on reviewing medical records, identifying inappropriate or unsupported diagnoses, and guiding compliant documentation.

You will educate providers, perform QA audits, validate face-to-face encounters, and stay aligned with Medicare Managed Care requirements.