HCC Coding Specialist

TL;DR

HCC Coding Specialist (HCC/Risk Adjustment): Perform Hierarchical Condition Category (HCC) coding for Medicare Advantage (MA), Affordable Care Act (ACA), and ESRD projects with an accent on CMS coding guidelines, ICD-10 diagnosis mapping, and maintaining RPM coding accuracy. Focus on supporting RADV audits, partnering with physicians and internal teams to improve documentation and capture correct risk adjustment coding, and driving process improvements through analysis and education.

Location: Working at Home - Pennsylvania

Company

hirify.global provides healthcare and health plan services, including risk adjustment coding support for government programs.

What you will do

• Perform HCC coding for MA, ACA, and ESRD, working across retro and prospective coding models using coding applications and electronic medical record systems.
• Adhere to CMS guidelines and Highmark policies to guide HCC coding decisions and maintain RPM coding accuracy and productivity requirements.
• Support Regulatory Audits by performing first coding review and chart ranking for RADV-related work.
• Analyze physician documentation to interpret ICD-10 diagnoses into HCC disease categories for RPM risk adjustment projects.
• Support documentation improvement and provider education by analyzing reports and identifying process improvements.
• Participate in ad-hoc departmental projects and attend RPM coding educational meetings and the annual coding Summit.

Requirements

• 3 years of HCC coding and/or coding and billing experience.
• 5 years of HCC coding and/or coding and billing experience.
• Certification (any of the following): CPC, CRC, CCS, or RHIT.
• Ability to work remotely from Pennsylvania (working at home).
• Strong attention to detail and critical thinking for coding accuracy.
• Written and oral communication skills for education and recommendations.

Culture & Benefits

• Remote office-based role with occasional travel (0%–25%) to work sites as needed.
• HIPAA and data security compliance required due to access to confidential information.
• Uses Microsoft Office suite (MS365/Teams) and coding applications to support productivity.

Hiring process

• Review of credentials and coding experience, including required certification.
• Assessment of coding accuracy, attention to detail, and communication skills during interviews.