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Type: Contract
Pay: Apply For Details
Location: Remote
Diagnosis Accuracy Coder – HCC / Risk Adjustment
Position Overview
Seeking an experienced Diagnosis Coder with a strong background in ICD-10-CM diagnosis coding and diagnosis accuracy. The primary focus of this role is ensuring diagnoses are accurately coded, appropriately supported by the clinical documentation, and reported at the highest appropriate level of specificity.
Candidates should also have experience working with HCC/Risk Adjustment coding across both Medicare and Commercial models. Professional fee experience is beneficial, but strong diagnosis coding expertise is the priority.
Primary Responsibilities
- Review clinical documentation for accurate ICD-10-CM diagnosis assignment
- Ensure diagnoses are coded to the highest appropriate level of specificity
- Validate that coded diagnoses are fully supported by the medical record
- Identify missed, unsupported, incorrectly coded, or insufficiently specific diagnoses
- Apply official ICD-10-CM coding guidelines and organizational standards
- Recognize documentation gaps requiring provider clarification
- Evaluate chronic conditions and their appropriate capture/recapture
- Apply diagnosis coding within Medicare/CMS and Commercial/HHS risk adjustment models
- Understand the HCC impact of diagnosis coding decisions without allowing HCC capture to override coding accuracy
- Maintain established quality and productivity expectations
- Incorporate audit feedback and education into daily coding practices
Required Experience
- Strong diagnosis coding experience is the #1 priority
- Advanced knowledge of ICD-10-CM diagnosis coding
- Demonstrated experience reviewing records specifically for diagnosis accuracy
- Strong understanding of:
- Coding specificity
- Clinical documentation requirements
- Chronic condition coding
- Supported vs. unsupported diagnoses
- Appropriate diagnosis reporting
- HCC / Risk Adjustment coding experience
- Experience with both Medicare/CMS and Commercial/HHS risk adjustment models
- Ability to defend coding decisions based on documentation and coding guidelines
Preferred Experience
- Professional Fee / physician coding experience
- Ambulatory or physician-practice coding
- Prospective and/or retrospective risk adjustment review
- Provider query/clarification experience
- Experience with chronic condition capture and recapture
- Experience working across multiple physician specialties
Certifications
Preferred:
- CRC
- CPC
- CCS-P
- CCS
Ideal Candidate
The ideal candidate is a strong diagnosis coder first and an HCC coder second.
We are looking for someone who can look at the clinical documentation and determine what should and should not be coded, rather than simply searching the chart for diagnoses that map to an HCC.
They should understand the impact of diagnosis coding on risk adjustment while maintaining coding accuracy, documentation support, and compliance as the priority.
Recruiter Screening – What Matters Most
Prioritize candidates in this order:
1. Diagnosis Coding
Can they demonstrate strong ICD-10-CM diagnosis coding knowledge and explain how they determine whether a diagnosis is appropriately supported?
2. Diagnosis Accuracy
Have they actually reviewed charts for missed, unsupported, inaccurate, or insufficiently specific diagnoses?
3. HCC Experience
Do they understand risk adjustment and HCC capture beyond simply recognizing HCC codes?
4. Medicare + Commercial
Have they worked hands-on with both CMS/Medicare and HHS/Commercial models?
5. ProFee
- Professional fee experience is valuable, but do not eliminate an otherwise strong diagnosis/HCC coder solely because their ProFee background is lighter.
Job Id: a1sVb000005ElqbIAC