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HCC Auditors

Location: Nationwide
Category: Healthcare
Employment Type: Contract

HCC Auditor/Educator Job Order:

The HCC Auditor will do a review of medical records to determine the completeness and accuracy of HCC coding by ensuring that the assigned codes and HCC codes are supported by clinical documentation.

Potential Responsibilities: 
Reviews medical records  to ensure documentation accurately reflects and supports code selection based on the ICD-10 coding guidelines, which are submitted to CMS for reimbursement based on the CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives. Performs physician queries as needed in order to validate ICD-10 diagnosis codes and follows established physician query policy and procedure. Ensures the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted CMS timeframe.

- Provide education and training to physicians, and appropriate office staff on correct coding protocol and guidelines

Average Qualifications:

- Required: 2-5 years experience with coding validation and knowledge of Medicare HCC coding protocol


Required: Coding Certification from AAPC or AHIMA
- Certified Professional Coder (CPC); or
- Certified Coding Specialist - Physician (CCS-P) or
- Certified Coding Specialist (CCS)

Knowledge, Skills and/or Abilities -

Knowledge of ICD-10-CM, CPT and HCPCS coding, and regulatory requirements.

Knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes and pharmacology.

Knowledge of Risk Adjustment methodology experience preferred Proficient knowledge of CMS-HCC Model and guidelines.

Ability to interpret, analyze and abstract data/documentation Ability to identify HCC improvement opportunities and provide feedback to physicians on proper clinical documentation, compliance, and coding guidelines.

Excellent organization and problem-solving skills required. Strong oral and written communication skills required. Strong time management skills required. Ability to work in a continuously changing environment.

Must possess a high degree of accuracy, efficiency and dependability. Ability to work effectively as a team member.