HCC Coder - USFTGP Accountable Care Org

February 4, 2026

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Responsible for providing coding quality auditing services and evaluating clinical documentation for all providers within the USFTGP organization. Establishes and provides timely communication of identified quality issues concerning documentation and coding with a target minimum of a 95%25 accuracy/passing rate. More specifically this team member will: <ul><li>Audit retro and concurrent medical provider clinical documentation while adhering to Medicare guidelines • Review documentation to assign/audit correct diagnosis codes </li><li>Identify areas for documentation improvement and effectively communicates with providers and staff. </li><li>Perform in a professional manner, exercising good judgment and ethical standards. Interacts effectively and builds respectful working relationships across the organization. • Demonstrate integrity by adhering to high standards of personal and professional conduct. </li><li>Comply with the Standards of Ethical Coding as set forth by the American Health Information Management Association and adhere to official coding guidelines. </li><li>Knowledge of HIPAA, recognizing a commitment to privacy, security and confidentiality of all medical chart documentation. </li><li>Be reliable and maintain a high level of confidentiality within all aspects of job performance.</li></ul> CPC, COC, CCA, CCS, CRC, RHIA, or RHITTwo years coding and auditing experience; at least 12 months of experience performing HCC Coding Required. 2. Advanced knowledge of ICD-10-CM, working knowledge of CPT and HCPCS 3. Active coding credentialing required through either AHIMA or AAPC, CRC is preferred 4. A comprehensive understanding of CMS guidelines for risk adjustment and proficiency in HCCKey Accountabilities <ul><li>Identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories. </li><li>Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered. </li><li>Review medical record information to identify all appropriate coding based on CMS HCC categories. </li><li>Complete appropriate paperwork/documentation/system entry regarding claim/encounter information. </li><li>Provide support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards. </li><li>Monitor Coding changes to ensure that most current information is available. </li><li>Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information. </li><li>Queries when documentation in the record is inadequate, ambiguous, or otherwise unclear for medial coding purposes</li><li>Remain current on medical coding guidelines and reimbursement reporting requirements. </li><li>Identify common coding errors identified in RADV audits. </li><li>Assist TGMG leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes</li></ul>

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