HCC Lead Coder/Auditor - Wakely

Job Summary

The HCC Lead Coder/Auditor is responsible for performing advanced coding and audit reviews of outpatient medical records to validate the integrity of ICD-10 diagnoses and CPT-coded procedures. This role applies deep knowledge of coding guidelines, risk adjustment methodologies, and regulatory requirements to ensure accuracy, compliance, and optimal reimbursement. This position includes direct interaction with clients and requires the ability to clearly communicate audit findings, provide recommendations, and support documentation improvement efforts.

Responsibilities

• Design and deliver targeted coding education based on audit findings, regulatory updates, and client needs.
• Develop training materials, presentations, and reference guides to support internal teams and client stakeholders.
• Translate complex coding guidelines, audit results, and regulatory requirements into clear, actionable guidance.
• Lead efforts to improve clinical documentation practices in alignment with risk adjustment requirements.
• Serve as a subject matter expert in ICD-10 coding and risk adjustment models (CMS-HCC and/or HHS-HCC).
• Provide expert consultation on complex coding scenarios and documentation challenges.
• Monitor regulatory and industry changes and communicate impacts to internal teams and clients.
• Influence coding and documentation practices through education, consultation, and stakeholder engagement.
• Partner with leadership to identify opportunities to enhance coding accuracy, documentation integrity, and client outcomes.
• Collaborate with internal teams and external partners to improve coding tools, workflows, and emerging technologies (e.g., LLMs).

Qualifications

• Minimum of a high school diploma is required; an associate’s or bachelor’s degree is preferred.
• A current certification from AHIMA or AAPC is required (e.g., CPC, CCS-P, RHIA, RHIT, CPMA).
• A Certified Risk Adjustment Coder (CRC) certification is also required.
• Minimum of five years of experience in medical coding and/or auditing is required.
• Experience working with risk adjustment models, including CMS-HCC and/or HHS-HCC, is strongly preferred.
• Experience supporting or participating in RADV and/or HRADV audits is preferred.
• Advanced knowledge of ICD-10 coding guidelines, medical terminology, and reimbursement methodologies.
• Strong analytical skills with the ability to identify trends and provide actionable recommendations.
• Ability to interpret complex medical records and apply appropriate coding standards.
• Strong written and verbal communication skills, including the ability to present findings to clients.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office and coding/audit systems.