HCC Coder - Risk Adjustment

Coding and CDI  
Full Time
Day Shift 
8a-5p - Mon-Fri

Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of its communities. Ranked #2 in the state and #1 in the Columbia metro area by U.S. News & World Report, Lexington Medical Center is the only hospital named one of the Best Places to Work in South Carolina.

The 607-bed hospital anchors a health care network that includes five community medical centers and employs nearly 8,000 health care professionals. The network includes a cardiovascular program recognized by the American College of Cardiology as South Carolina’s first HeartCARE CenterTM and an accredited Cancer Center of Excellence affiliated with MUSC Hollings Cancer Center for research and education. The network also features an occupational health center, the largest skilled nursing facility in the Carolinas, an Alzheimer’s care center and nearly 80 physician practices.





Job Summary

Provides thorough concurrent, prospective, and retrospective review of ambulatory medical record clinical documentation to ensure accurate and complete capture of the clinical picture, severity of illness, and complexity of the patient.  Utilizes knowledge of official coding guidelines (ICD-10, CPT, HCPCs), Hierarchical Condition Categories (HCC), M.E.A.T (Monitored, Evaluated/Assessed/Addressed, Treated) standards, Risk Adjustment Factor (RAF) scoring, and AHIMA/ACDIS physician query brief.  Provides education to providers on the importance of diagnosis specificity.  May participate in developing, presenting, and disseminating provider communication and other activities related to clinical documentation.  

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 2 Years of Professional Coding Experience
Substitutable Education & Experience: None.
Required Certifications/Licensure: Candidates must have one of the following certifications: Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC) or Certified Coding Specialist Certification; 
Candidates hired without Certified Risk Adjustment Coder (CRC) certification must obtain certification within first year of entry into role. 
Required Training: None.

Essential Functions

  • Concurrently, prospectively, and retrospectively reviews medical records to identify unclear, ambiguous or inconsistent documentation.
  • Utilizes approved resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCs and ensures documentation in the medical record follows official coding guidelines, internal guidelines, and AHIMA/ACDIS physician query brief.
  • Provides ongoing feedback to physicians and other providers regarding coding guidelines and requirements, including education and support for improvement in HCC coding and RAF scoring. Assists with educational in-services for physicians, other providers, and clinic staff relating to clinical documentation compliance related to billing.

Duties & Responsibilities

  • Maintains complete confidentiality of patient information
  • Maintains competency in evolving areas of coding.
  • Collaborates with other LMC departments as needed.
  • Performs all other duties as assigned.

We are committed to offering quality, cost-effective benefits choices for our employees and their families:

  • Day ONE medical, dental and life insurance benefits 
  • Health care and dependent care flexible spending accounts (FSAs)
  • Employees are eligible for enrollment into the 403(b) match plan day one.  LHI matches dollar for dollar up to 6%.
  • Employer paid life insurance – equal to 1x salary
  • Employee may elect supplemental life insurance with low cost premiums up to 3x salary 
  • Adoption assistance
  • LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
  • Tuition reimbursement
  • Student loan forgiveness

Equal Opportunity Employer
It is the policy of LMC to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. LMC strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. LMC endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee’s desires and abilities and the hospital’s needs.

Nearest Major Market: Columbia
Nearest Secondary Market: South Carolina