HCC Coder

About Us

PedIM Healthcare is the first private medical office of its kind in Citrus County – offering top-quality care for children, adults, and seniors all under one roof. We provide pediatric, adult internal medicine, family practice, geriatrics, women’s care, medical weight-loss, sleep-medicine services and more. Our dedicated, community-focused team is committed to excellence, pride in service, and making a real difference for patients and families across Citrus County.

A broad, multi-discipline practice where you can grow: pediatrics, internal medicine, weight-loss & sleep medicine specialties. A values-driven environment: we listen, we help, we understand—and we care. Community-oriented and recognized: voted “best of the best” in the region. Opportunity to make a meaningful impact by supporting patients over their full life span—from children to seniors. A workplace committed to employee development and delivering holistic care.

About the Role

We are seeking a proactive and compassionate HCC Coder to join our Primary Care team! This role is critical to ensuring accurate risk adjustment, complete documentation, and compliance with CMS guidelines while supporting high-quality patient outcomes. You will be responsible for reviewing medical records, identifying appropriate HCC diagnoses, ensuring documentation integrity, and collaborating closely with providers and clinical teams to optimize RAF scores and coding accuracy.

Responsibilities

• Conduct pre-visit and chart reviews to identify known and suspected RAF/HCC conditions prior to patient appointments
• Conduct post-visit chart reviews to ensure all RAF/HCC opportunities have been captured by the medical provider prior to claims submission/billing
• Conduct post claims submission reconciliation from payer to ensure all codes have been properly accounted for through files such as MOA004, MOR and MMR
• Review provider documentation and assign accurate ICD-10 and HCC codes
• Identify documentation gaps and provide clear, actionable feedback to providers
• Track coding trends and identify performance improvement opportunities
• Collaborate closely with Clinical Integrity, Outreach, and Provider Teams
• Maintain established productivity and quality benchmarks
• Stay current with CMS risk adjustment guidelines and regulatory updates

Requirements

• Minimum 2+ years of HCC/Risk Adjustment coding experience (required)
• Strong knowledge of CMS risk adjustment methodology and Medicare Advantage models
• Active coding credential preferred (CRC, CPC, CCS, or equivalent)
• Proven experience with chart audits and provider education
• Experience performing pre and post-visit RAF reviews preferred
• Strong analytical skills and attention to detail
• Experience with EHR systems required
• Value-based care experience strongly preferred

Benefits

• Health coverage + Sick-N-Well membership
• Health Savings Account (HSA)
• Life insurance
• Paid time off
• 401(k) plan + 4% company match
• Relax Scofa membership
• Employee Assistance Program (EAP)
• Employee Recognition Program

All employment offers are contingent upon the successful completion of applicable background checks, verification of credentials, and compliance with health and safety requirements.