What is an HCC Risk Adjustment Coder?

An HCC Risk Adjustment Coder reviews medical records to identify and assign accurate Hierarchical Condition Category (HCC) codes based on documented diagnoses. These codes help determine risk adjustment scores, which impact healthcare reimbursements for Medicare Advantage and other risk-adjusted plans. Coders ensure compliance with CMS guidelines, improve documentation accuracy, and support proper reimbursement for patient care. Strong knowledge of ICD-10-CM coding, medical terminology, and risk adjustment models is essential for this role.