Senior HCC Coder in Palm Springs, Florida at PBACO Holding LLC

Our multi-site primary care medical group is hiring a Senior HCC Coder to lead risk adjustment coding, auditing, and provider education across our Palm Beach County clinics. You will own the chart review program for our Medicare Advantage and Traditional Medicare FFS lines of business and turn what you find in the charts into practical, provider-specific documentation improvement.

This is a hands-on, field-based role. You will spend most of your time in PCP offices reviewing documentation, meeting with physicians and site leaders, and delivering education in person, with a home base at our West Palm Beach office. You will partner with our Performance Improvement and ACO teams and with health plan partners to keep our HCC and HEDIS chart review process aligned with CMS regulations, ICD-10-CM guidelines, and payor expectations.

The ideal candidate is both a coding subject matter expert and a confident communicator: someone who can explain complex risk adjustment concepts to busy physicians, build trust across multiple sites, and show measurable improvement in RAF accuracy, HCC recapture, and documentation quality.

Chart review and auditing

• Implement and lead a standardized HCC and HEDIS chart review program across assigned PCP offices, in line with health plan expectations and CMS regulations.
• Perform prospective, concurrent, and retrospective chart reviews to confirm documentation supports each diagnosis and code, and to identify HCC capture gaps and recapture opportunities.
• Review charts and validate diagnosis coding before claims submission; flag discrepancies for correction before claims go out.
• Conduct HEDIS chart reviews and quality measure abstraction, identifying care gaps and documentation deficiencies tied to key quality measures.

Provider education and training

• Design and deliver HCC coding education for PCPs, APPs, and clinical documentation staff, tailored to each provider's documentation trends and coding patterns.
• Lead live and virtual group sessions, one-on-one provider coaching, and site-level trainings on documentation specificity, risk adjustment accuracy, and coding compliance.
• Build a customized education plan for each assigned provider based on chart review findings.
• Develop job aids, quick-reference tools, provider scorecards, and other materials that reinforce education between sessions.
• Support risk adjustment onboarding for new providers.

Reporting and analytics

• Create and present chart audit reports and metrics based on review findings.
• Interpret payor risk adjustment reports (suspect lists, gap reports, RAF/HCC performance reports) and translate them into targeted education and site-level action plans.
• Track and report provider coding performance, RAF accuracy, HEDIS gap closure, and training outcomes to leadership.

Relationships and collaboration

• Build strong, trust-based relationships with physicians, practice administrators, office staff, and site leadership in Palm Beach County.
• Partner with Performance Improvement, ACO, coding, and compliance teams to identify process improvement opportunities.
• Serve as a liaison with health plan and payor partners, participating in payor meetings on coding accuracy and documentation initiatives.
• Connect providers and office staff with additional health plan resources as needed.

Regulatory currency

• Stay current on CMS-HCC, HHS-HCC, RxHCC, and ESRD risk adjustment models, ICD-10-CM guidelines, HEDIS/NCQA requirements, and payer-specific rules; update training content as they change.

• High school diploma or GED required; associate degree or higher preferred, or equivalent job-related experience.
• Active coding credential: CRC (Certified Risk Adjustment Coder) preferred; CPC, CCS, CCS-P, RHIT, RHIA, or equivalent also considered.
• Minimum 4 years of HCC/risk adjustment coding experience, including at least 2 years of direct provider interaction delivering coding or documentation education to primary care providers.
• Proven track record of improving risk coding accuracy (RAF accuracy, HCC recapture, documentation improvement metrics).
• Strong working knowledge of CMS-HCC and/or HHS-HCC, RxHCC and ESRD risk adjustment models, ICD-10-CM coding guidelines, and CMS documentation requirements.
• Hands-on experience conducting prospective, concurrent, and retrospective chart reviews and audits for risk adjustment.
• Working knowledge of HEDIS measures and quality chart abstraction, with the ability to communicate care and documentation gaps to providers.
• Experience interpreting payor coding reports (suspect lists, gap reports, RAF/HCC performance data) and using them to drive provider education.
• Ability to validate diagnosis accuracy prior to claims submission.
• Strong presentation and public speaking skills, with demonstrated ability to train and engage physicians and clinical staff individually and in groups.
• Excellent interpersonal skills and a track record of effective collaboration with physicians, practice administrators, and site leadership.
• Strong analytical skills; comfortable interpreting coding and audit data to shape education strategy.
• Highly organized and self-directed; able to manage review and training schedules across multiple clinic locations.
• Computer proficiency (MS Windows, MS Office, internet) and working knowledge of HIPAA privacy and security requirements.

• Additional credentials: CPMA, CDEO, CDI, or CPC-I.
• Experience in a multi-site primary care, ACO, or value-based care organization.
• Background supporting Medicare Advantage risk adjustment programs specifically.
• Experience liaising directly with payors or health plans on coding performance and accuracy.
• Familiarity with EHR-based documentation workflows and coding/audit software tools.
• Experience developing formal curricula or structured provider education programs.
• Experience with HEDIS reporting cycles, NCQA requirements, or Stars/quality programs.

• Full-time, on-site role based in Palm Beach County, Florida. Candidates must be local.
• Local travel to physician offices is required up to 90% of the time; a valid driver's license and reliable vehicle are required.
• Works from the company's West Palm Beach office when not traveling to practice sites.

• Participates in decision-making and process improvement regardless of position in the organization.
• Communicates effectively, verbally and in writing, sharing information in a timely and respectful manner and facilitating successful handoffs.
• Treats everyone ethically, fairly, compassionately, and without judgment.
• Protects the privacy, security, and confidentiality of all medical chart documentation in accordance with HIPAA.
• Reports safety and risk issues; completes regulatory and annual requirements on time.
• Presents professionally, meets appearance policy standards, and wears a name badge on duty.
• Reports to work on time and as scheduled; completes work within designated timeframes.
• Performs other duties as assigned and is willing to support other departments as needed.