HCC Coding Specialist (Telecommute)

Date: Aug 30, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5183 


Position Summary/Position


Under the direction of the Risk Adjustment Leadership Team, the HCC Coding Specialist performs on- going chart review projects and activities in an effort to improve IEHP HCC/RAPS reporting to CMS. This position is responsible for collecting, reviewing, validating, and submitting pertinent HCC diagnostic data from both internal and external sources. The HCC Coder collects information related to HCC reconciliation and assists in IEHP efforts aimed to maximize medical record documentation standards, coding standards, and Member care. Develop measurement tools to report effectiveness of HCC reviews at the Provider level. Assist in identifying potential coding patterns and areas needed for provider educational outreach.

Major Functions (Duties and Responsibilities)


1. Performs ongoing HCC-related improvement projects assigned by the HCC Subcommittee or Clinical Informatics Manager in an effort to compile accurate and complete ICD-10 physician coding and maximize IEHP’s HCC results.
2. Conducts clinical chart reviews, perform audits, and on-site reviews using prioritized HCC target lists.
3. Analyzes IEHP claim and encounter data to identify incomplete or inaccurate ICD-10 coding patterns submitted at the physician level. Use this data to develop targeted educational outreach to physician offices.
4. Works closely with the HCC Subcommittee in identifying opportunities for HCC coding education and business strategies within the IEHP Provider Network.
5. Develops educational coding materials for use in provider education outreach activities.
6. Develops measurement tools to assess HCC data adequacy and identifying deficient coding patterns and provider educational needs.
7. Conducts provider training sessions related to proper HCC coding practices.
8.  Demonstrate a commitment to incorporate LEAN principles into daily work.

Experience Qualifications


Two (2) years experience in HCC Coding. Must have strong chart audit experience in HCC coding. AHIMA or AAPC Certified Coder with experience in managed care, program/project  management, data  analysis and interpretation.

Preferred Experience


Experience in HCC Coding in an HMO Setting is preferred.

Education Qualifications


High school diploma or GED required.

Professional Certification


AHIMA or AAPC Certified Coder required. CRC certification preferred. 

Professional Licenses


Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license preferred or Vocational Nurse (LVN) License issued by the California BRN preferred.

Drivers License Required

Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Knowledge Requirement


Working knowledge of Centers for Medicare & Medicaid Services (CMS) HCC coding requirements, ICD-10 and CPT guidelines are required. Knowledge in HCC-Risk Adjustment process and health insurance concepts as they relate to Medicare Advantage and Part D plans is required.

Skills Requirement


Excellent written, oral, and presentation skills. Proficiency in Microsoft Word, Excel, and other computer applications.

Abilities Requirement


Ability to take general direction and manage complex projects within deadlines. Must have attention to detail and the ability to organize and prioritize.

Commitment to Team Culture


The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions


While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. Must have reliable transportation, current automobile insurance, and a current state-issued driver’s license.


Starting Salary: $66,040.00  - $84,219.20  

Pay rate will commensurate with experience


Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles