Lead Hierarchical Condition Category (HCC) Coding Specialist (Medical Coding)

TL;DR

Lead Hierarchical Condition Category (HCC) Coding Specialist (Medical Coding): Performing HCC coding and quality assurance for risk-adjusted government programs with an accent on CMS guidelines and RADV audits. Focus on conducting QA reviews, managing provider coding trends, and mentoring internal coding teams to ensure documentation accuracy.

Location: Remote (Must be based in Pennsylvania, USA)

Company

hirify.global is a leading healthcare organization providing comprehensive health plan and clinical services to its beneficiaries.

What you will do

• Perform Quality Assurance (QA) reviews of internal coders and vendors, providing detailed feedback and education.
• Lead Government Audits (including IPM, CON-RADV, ACA-RADV, and OIG), managing coding adjudication and rebuttals.
• Analyze coding trends for strategic provider entities and deliver presentations to improve documentation accuracy.
• Execute HCC coding for MA, ACA, and ESRD projects while strictly adhering to CMS guidelines.
• Mentor new hires and develop onboarding and training materials.
• Collaborate with cross-functional teams to optimize data collection and provider outreach.

Requirements

• Must be based in Pennsylvania, USA.
• 5-7 years of HCC risk adjustment coding experience.
• 3 years of experience in RADV audits and Coding QA.
• 1 year of management or leadership experience.
• Bachelor's or Associate's degree in medical billing/coding, healthcare, or a related field.
• Required certifications: CPC, CRC, CCS, or RHIT.

Nice to have

• Experience as an LPN or RN.

Culture & Benefits

• Remote work flexibility for eligible candidates based in Pennsylvania.
• Opportunities for professional growth through mentoring and leading key strategic accounts.
• Collaborative environment with cross-team engagement.
• Regular participation in coding education meetings and Annual Coding Summits.