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Seasonal Hcc Risk Adjustment Coding Jobs in Oklahoma

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Seasonal Hcc Risk Adjustment Coding information

What are the most common challenges faced by professionals in seasonal HCC risk adjustment coding roles, and how can they be managed?

Seasonal HCC Risk Adjustment Coders often face the challenge of managing high volumes of medical records within tight deadlines, especially during peak audit or submission periods. Ensuring coding accuracy and compliance with evolving CMS guidelines can also be demanding, as even minor errors may impact reimbursement and risk scores. Staying organized, regularly participating in training updates, and leveraging coding software tools can help manage workloads and maintain accuracy. Collaborating closely with clinical teams and other coders is vital for clarifying documentation and sharing best practices.

What is a seasonal HCC risk adjustment coder?

A Seasonal HCC Risk Adjustment Coder is a healthcare professional who reviews medical records to identify and code diagnoses that impact risk adjustment scores, typically during peak periods such as the Medicare Advantage sweep season. HCC stands for Hierarchical Condition Category, a coding system used by Medicare to predict healthcare costs based on patient diagnoses. These coders ensure accurate documentation, which directly affects insurance reimbursement and compliance. Seasonal roles are common due to the cyclical nature of risk adjustment reporting deadlines.

What is the difference between Seasonal Hcc Risk Adjustment Coding vs Hcc Risk Adjustment Coding?

AspectSeasonal Hcc Risk Adjustment CodingHcc Risk Adjustment Coding
CredentialsCertifications in coding and risk adjustmentCertifications in coding and risk adjustment
Work EnvironmentHealthcare facilities, insurance companies, remoteHealthcare facilities, insurance companies, remote
Industry UsageUsed seasonally for specific risk adjustmentsUsed year-round for ongoing risk management
Search IntentUnderstanding seasonal coding differencesGeneral risk adjustment coding practices

Seasonal Hcc Risk Adjustment Coding focuses on coding practices during specific times of the year, often related to seasonal health trends. In contrast, Hcc Risk Adjustment Coding involves continuous coding to manage patient risk profiles throughout the year. Both roles require similar certifications and work environments but differ mainly in their temporal focus and application.

What are the key skills and qualifications needed to thrive as a seasonal HCC risk adjustment coder?

To thrive as a Seasonal HCC Risk Adjustment Coder, you need a strong understanding of ICD-10-CM coding, risk adjustment methodologies, and a certification such as CPC, CRC, or CCS. Proficiency in coding software, electronic health records (EHRs), and risk adjustment platforms is typically required. Attention to detail, analytical thinking, and strong organizational skills help ensure accuracy and compliance in reviewing medical records. These skills are essential to accurately capture patient risk profiles, support healthcare reimbursement, and maintain regulatory compliance.
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Seasonal Hcc Risk Adjustment Coding jobs near you

Risk Adjustment - Risk Adjustment Coding Auditor

CommunityCare

Tulsa, OK • On-site

$23.50 - $27/hr

Other

Posted 5 days ago

Job description

JOB SUMMARY:
The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity.
KEY RESPONSIBILITIES:
• Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements.
• Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines.
• Identify unsupported diagnoses, over coding, under-coding, and documentation gaps.
• Provide detailed audit findings and recommendations to coding teams, providers, and leadership.
• Monitor compliance with CMS Risk Adjustment Data Validation (RADV) standards.
• Track and report audit results, trends, and performance metrics.
• Collaborate with coding staff, providers, and operations teams to improve documentation quality and coding accuracy.
• Assist with education and training initiatives related to risk adjustment and documentation best practices.
• Maintain confidentiality and ensure compliance with HIPAA regulations.
• Meet daily and weekly productivity goals and quality standards set by the supervisor.
• Perform other job-related duties as required or assigned.
QUALIFICATIONS:
• Knowledge of CMS-HCC and HHS-HCC risk adjustment model.
• Knowledge of ICD-10-CM coding guidelines.
• Knowledge of RADV requirements.
• Proficiency in EMR systems and Microsoft Office (Excel preferred).
• High attention to detail.
• Strong analytical and critical thinking skills.
• Clear written and verbal communication.
• Ability to work independently and meet deadlines.
• Strong organizational skills.
• Integrity and commitment to compliance.
• Successful completion of Health Care Sanctions background check.
EDUCATION/EXPERIENCE:
• A minimum of two years of risk adjustment coding or auditing experience.
• Experience reviewing medical records across multiple specialties.
• Certified Professional Coder (CPC), CRC, CCS, or equivalent coding certification.
• Bachelor's degree in Health Information Management or related field preferred.
• Previous auditing experience in Medicare Advantage and ACA preferred.
• Experience with internal audit programs or payer audits preferred.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

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