Risk Adjustment HCC Coder- CDS

Are you a certified primary care medical coder who is passionate about improving the accuracy and integrity of patient records? Valley wise Health wants you to join our mission‑driven team focused on providing exceptional patient care through precise and compliant documentation.

In this critical role, you will collaborate with providers, coders, and clinical teams to ensure the outpatient medical record tells the full story of the patient’s encounter. You will work under the direction of the Clinical Documentation Improvement Supervisor and utilize a hybrid work environment to improve overall quality and completeness of clinical documentation within the patient electronic medical record using concurrent and/or retrospective review processes.

You will work collaboratively with CDI nurses to ensure that the clinical information within the medical record is accurately coded and supported with the provider’s documentation, including accurate documentation to support the capture of Hierarchical Condition Categories (HCC) and Risk Adjustment Factors (RAF), along with ICD‑10‑CM specificity. You will also perform retrospective reviews and apply ICD‑10‑CM and CPT codes to the medical records to ensure services are captured on the claim form and ensure compliance with all applicable federal laws and regulations related to coding and documentation guidelines for HCC capture.

Additionally, you will participate in ongoing documentation improvement initiatives, including formal and informal education provided to outpatient providers.

Valley wise Health is committed to providing high‑quality, comprehensive benefits designed to help our employees and their families stay physically and financially fit. Our benefits include:

• Medical, Dental, and Vision Plans
• Flexible Spending Accounts
• 100% Retirement Match in the Arizona State Retirement System (ASRS)
• Paid Time Off and Paid Holidays
• Sick and Extended Illness Bank
• Tuition Reimbursement Programs
• And much more!

Hourly Rate: $34.15 - $50.37

Requires an associate degree in Health Information Technology (HIT) or an equivalent combination of training and experience.

• Requires three (3) years of experience coding in a primary care provider’s office or facility-based provider clinic for internal medicine/family practice.
• Must know coding Medicare Annual Wellness Visits and HCC reporting guidelines.
• Prefers experience with HCC coding.
• Prefers experience with value‑based reporting.

• Requires the ability to pass a coding exam before hire.
• Requires experience with Electronic Health Record, Encoder, and Microsoft Office software.
• Prefers experience with EPIC and 3M Encoder Software Systems.

• Must possess a CCS, CCS‑P, COC, or CPC certification.
• Must possess a valid driver’s license.
• Prefer Certified Risk Adjustment Coder (CRC) and Certified Clinical Documentation Specialist‑Outpatient (CCDS‑O).

• Must have in‑depth knowledge and a clear understanding of coding principles to validate and apply missing, incomplete, or incorrect diagnosis ICD‑10‑CM & CPT codes.
• Must be able to demonstrate the difference between a problem‑oriented visit, a preventative visit, and the Annual Wellness Visit criteria.
• Must clearly understand HCC and RAF.
• Must have advanced knowledge of medical terminology, anatomy, and physiology.
• Must have excellent customer service skills when communicating with physicians and clinic staff.
• Must achieve and maintain appropriate CDS productivity standards as established by CDI Department Policy and Procedure.
• Must adhere to the Standards of Ethical Coding set forth by the American Health Information Management Association (AHIMA) and AAPC.
• Must have a high level of computer proficiency with Microsoft Office, Electronic Health Records, and encoder systems.
• Knowledge of HIPAA and commitment to privacy, security, and confidentiality of medical charts.
• Must possess analytical skill to interpret data and assign appropriate codes.
• Must use problem‑solving skills to assess work queue or coding‑related issues.
• Must prioritize and multitask to meet department objectives.
• Can work independently and collaboratively within a team.
• Can accept and incorporate critical feedback.
• Well‑organized and detail‑oriented.
• Fluent in reading, writing, and speaking English.
• Must work remotely or on‑site in ambulatory clinics.
• Must travel to ambulatory clinics, as needed, to perform provider education and observe clinic workflows.
• Proficient with MS Windows, MS Office, and the internet.