Contractual Remote Hcc Coder Jobs in Raleigh, NC

• Team Leadership & Oversight: Lead, mentor, and manage a team of  QA Specialists. Establish team goals, monitor productivity, conduct regular performance reviews, and foster a culture of continuous learning.
• Quality Audits: Oversee and perform comprehensive quality assurance reviews for coding completed by internal CDI staff and external vendor partners, ensuring compliance with official ICD-10-CM guidelines and risk adjustment models.
• SOP & Guideline Development: Design, implement, and maintain standard operating procedures, audit workflows, scoring methodologies, and coding quality guidelines across the organization.
• Payer Audit Support: Act as a key subject matter expert (SME) during external payer audits (e.g., RADV, Medicare, Commercial). Assist with chart selection, review, dispute documentation, and appeal responses.
• Vendor Management: Evaluate third-party coding vendor accuracy rates against established SLAs. Deliver constructive feedback, identify trend errors, and drive corrective action plans when necessary.
• Education & Feedback Loops: Translate QA audit findings into actionable insights. Provide structured feedback and target educational resources to internal CDI specialists and vendors to prevent recurring errors.
• Other duties as assigned

• Bachelor’s Degree in health care management, nursing or related field or an Associate Degree with relevant experience in CDI, coding, coding management, or HCC Risk Adjustment required.
• Minimum of 4 years of HCC coding experience with 2 years specifically focused on coding quality assurance, auditing, or compliance monitoring.
• Active professional credentials from AAPC and/or AHIMA required (such as CRC, CCS, CPC, or CPMA).
• Deep mastery of ICD-10-CM coding, CMS Risk Adjustment guidelines, RADV audit rules, and clinical documentation requirements.

• CRC (Certified Risk Adjustment Coder)
• Experience working within Value-Based Care (VBC) models, ACOs, or Advantage plans.
• Prior experience managing small teams or leading vendor oversight programs.
• Exceptional leadership, communication, and organizational skills.
• Proficiency with EHR systems and encoder software

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