Hierarchical Condition Category (HCC) Coding Specialist

This role delivers value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs like Medicare Advantage and the Affordable Care Act by utilizing Hierarchical Condition Category coding and clinical expertise. The specialist analyzes physician documentation to interpret ICD-10 diagnoses and HCC disease categories, ensuring compliance with CMS requirements and supporting Remote Patient Monitoring risk adjustment projects. The position involves collaborating with physicians and internal teams to drive accurate risk adjustment coding capture and documentation improvement.