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Hcc Coding Jobs in California (NOW HIRING)

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Hcc Coding information

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$15

$27

$42

How much do hcc coding jobs pay per hour?

As of Sep 1, 2026, the average hourly pay for hcc coding in California is $27.13, according to ZipRecruiter salary data. Most workers in this role earn between $18.75 and $34.18 per hour, depending on experience, location, and employer.

What is HCC coding?

HCC coding stands for Hierarchical Condition Category coding, which is a risk adjustment model used primarily by Medicare to estimate future healthcare costs for patients. HCC coders review medical records to identify and assign the appropriate ICD-10 codes that capture a patient's diagnoses and health conditions. Accurate HCC coding ensures proper reimbursement for healthcare providers and helps reflect the complexity of a patient’s health status. This process is essential for risk adjustment in value-based care models.

What are the key skills and qualifications needed to thrive as an HCC coder?

To thrive as an HCC Coder, you need a solid understanding of medical coding, risk adjustment models, and clinical documentation, typically with a certification such as CPC, CCS, or CRC. Familiarity with coding software, EHR systems, and the CMS HCC risk adjustment model is essential. Attention to detail, analytical thinking, and effective communication skills distinguish top performers in this field. These skills ensure accurate coding for risk adjustment, which directly impacts healthcare reimbursement and compliance.

What are some common challenges faced by HCC coders, and how can they be addressed in a healthcare setting?

HCC Coders often encounter challenges such as incomplete or ambiguous medical documentation, frequent updates to coding guidelines, and the need for ongoing collaboration with providers to ensure accurate capture of risk adjustment data. These challenges can be addressed by maintaining open communication with clinicians, participating in regular training on coding updates, and utilizing auditing tools to review and improve documentation quality. Proactively seeking clarification and staying current with industry standards are key to success in this role.

What is the difference between Hcc Coding vs Medical Coding?

AspectHcc CodingMedical Coding
Required CredentialsCertification (e.g., CPC, CCS), specialized training in HCCCertification (e.g., CPC, CCS), general medical coding training
Work EnvironmentHealthcare facilities, insurance companies, risk adjustment teamsHospitals, clinics, physician offices, insurance companies
Industry UsageRisk adjustment, Medicare Advantage, MedicaidBilling, reimbursement, medical record management
Search & Comparison IntentHcc Coding vs Medical CodingMedical Coding

Hcc Coding focuses on risk adjustment and insurance reimbursement, requiring specialized knowledge of Hierarchical Condition Categories. Medical Coding covers a broader range of medical billing and record-keeping tasks. While both roles involve coding, Hcc Coding is more specialized for insurance and risk management, whereas Medical Coding is essential for general healthcare billing and documentation.

Is HCC coding a good career?

HCC coding, which involves hierarchical condition category coding for risk adjustment, is a growing field with demand in healthcare organizations. It typically requires certification, attention to detail, and knowledge of medical terminology and coding systems, offering stable employment opportunities. The career can lead to roles in healthcare administration, compliance, and data analysis.

What does an HCC coder do?

An HCC coder reviews medical records and assigns Hierarchical Condition Category (HCC) codes to accurately reflect a patient's health conditions. This coding supports risk adjustment for insurance reimbursement and requires knowledge of medical terminology, coding guidelines, and often the use of specialized coding software. Accurate HCC coding is essential for proper payment and healthcare data analysis.

What are the most commonly searched types of Hcc Coding jobs in California?

The most popular types of Hcc Coding jobs in California are:

What are popular job titles related to Hcc Coding jobs in California?

For Hcc Coding jobs in California, the most frequently searched job titles are:

What job categories do people searching Hcc Coding jobs in California look for?

The top searched job categories for Hcc Coding jobs in California are:

What cities in California are hiring for Hcc Coding jobs?

Cities in California with the most Hcc Coding job openings:

Hcc Coding jobs near you
Infographic showing various Hcc Coding job openings in California as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $56,433 per year, or $27.1 per hour.

MSO PHYSICIAN REVIEWER

North East Medical Services

Burlingame, CA • On-site

$285K - $332K/yr

Other

Re-posted 28 days ago

Job description

The MSO Physician Reviewer is responsible for ensuring the appropriate utilization of healthcare services while maintaining high standards of patient care. This role involves conducting evidence-based medical necessity reviews for inpatient and outpatient services, assessing prior authorization requests, and supporting appeals and grievance processes. The Physician Reviewer collaborates with healthcare providers, UM team members, and case managers to facilitate efficient and effective care delivery.
In addition to utilization management, this role contributes case management, quality improvement initiatives, and risk adjustment analysis by identifying trends in healthcare utilization, evaluating provider documentation, and ensuring compliance with federal, state, and organizational policies. The Physician Reviewer provides clinical leadership in optimizing care pathways, reducing unnecessary hospitalizations, and enhancing patient safety.
This position requires a deep understanding of medical policies, healthcare regulations, and payer guidelines, including Medicare and Medicaid benefit coverage criteria. The ideal candidate will have strong analytical skills, excellent communication abilities, and a commitment to ensuring equitable, high-quality care. Work is varied, highly complex, and requires a high degree of discretion and independent judgment.
ESSENTIAL JOB FUNCTIONS:
  • Evaluate medical necessity, appropriateness, and efficiency of healthcare services using evidence-based criteria (e.g., MCG, CMS, and NCQA guidelines).
  • Review and assess prior authorization requests for procedures, hospital admissions, specialty referrals, and medications.
  • Provide peer-to-peer consultations with treating physicians to discuss medical necessity determinations and alternative treatment options.
  • Participate in the appeals and grievance process by reviewing denied claims and reconsidering medical necessity based on additional documentation.
  • Conduct retrospective and concurrent reviews of medical records to ensure accurate risk stratification and appropriate coding and documentation based on patient complexity.
  • Analyze Hierarchical Condition Category (HCC) coding and Risk Adjustment Factor (RAF) scores to identify documentation gaps and ensure alignment with CMS risk adjustment models.
  • Support provider education on proper documentation and coding practices to reflect complete and accurate disease burden and clinical acuity.
  • Participate in chart reviews and audits to ensure compliance with risk adjustment methodologies and HCC coding.
  • Evaluate coding trends and audit results to identify undercoded or miscoded diagnoses that may impact risk scores and compliance.
  • Work collaboratively with case managers, social workers, and care teams to optimize patient care and resource utilization.
  • Support efforts to reduce readmissions and enhance patient outcomes through evidence-based interventions.
  • Participate in quality improvement initiatives, such as identifying trends in over- or underutilization, gaps in care, or process inefficiencies.
  • Collaborate with clinical and operational leadership to develop protocols and guidelines that enhance patient safety and care quality.
  • Review and analyze clinical data to support performance improvement projects and accreditation requirements.
  • Performs other job duties as required by manager/supervisor.

  • Medical Degree (MD or DO) from an accredited institution.
  • Board Certification in a relevant specialty (Internal Medicine, Family Medicine, Emergency Medicine, or another applicable field).
  • Active and unrestricted medical license in California.
  • Minimum of 3-5 years of clinical experience; prior experience in utilization management, case review, HCC, risk adjustment, or managed care is preferred.
  • Knowledge of medical necessity criteria, healthcare regulations, and payer policies (Medicare, Medicaid, and/or commercial insurance).
  • Familiarity with UM guidelines (MCG, InterQual, CMS, NCQA, URAC) and utilization review process.
  • Experience conducting peer-to-peer reviews and provider education sessions.
  • Strong understanding of risk adjustment methodologies (e.g. HCC coding and RAF scoring) preferred.
  • Knowledge of value-based care models, population health management, and healthcare cost containment strategies.
  • Supervisory experience in a healthcare setting a plus.

LANGUAGE:
  • Must be able to fluently speak, read and write English.
  • Fluent in Chinese (Cantonese and/or Mandarin) preferred
  • Fluency in other languages are an asset.

STATUS:
  • This is an FLSA exempt position.
  • This is not an OSHA high-risk position.
  • This is a Full Time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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