HCC/CRR

Review patient medical records, encounter data, and clinical documentation for completeness and accuracy.

Assign appropriate ICD-10-CM diagnosis codes according to CMS-HCC and HHS-HCC guidelines.

Validate that all assigned codes are supported by documentation and align with current coding rules.

Identify and report documentation deficiencies to providers; assist in provider education to improve coding accuracy.

Work collaboratively with clinical and revenue cycle teams to ensure timely, accurate submission of risk adjustment data.

Maintain up-to-date knowledge of CMS risk adjustment models, coding regulations, and compliance requirements.

Participate in audits, data validation, and quality assurance activities.

Use EHR and risk adjustment tools to capture and track chronic conditions, demographics, and encounter-level data.

Essential Skills:

Strong understanding of medical terminology, anatomy, and pathophysiology.

Excellent attention to detail and analytical thinking.

Proficiency in EHR systems and coding software.

Ability to communicate effectively with providers and coding teams.

Performance Metrics

Coding accuracy rate (≥ 95%)

Timeliness of chart review and data submission

Compliance with CMS documentation and audit standards

Experience:

1–3 years of experience in HCC, risk adjustment, or medical coding.

Familiarity with CMS and HHS HCC models, ICD-10 coding, and Medicare Advantage documentation.