Medicare Hierarchical Condition Category Coder II

Job Category:  Provider Relations
Department:  Risk Adjustment Strategies & Initiatives

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  4829


Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Medicare Hierarchical Condition Category Coder II performs reviews, audits and codes medical records for the purpose of reimbursement, training, education and compliance using ICD-9 and CPT codes. The Medicare HCC Coder will utilize advanced knowledge of professional coding to review and recommend changes to systems and policies/procedures in order to ensure current and appropriate coding guidelines are maintained.


Audits and reviews medical documentation for appropriate ICD-9 and CPT coding and documentation. (20%)
Meets/follows up with physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. (20%)
Performs training and education for coding (internal/provider), documentation and claim payment guidelines, as well as addressing problems and issue. (5%) 

Reviews CPT and ICD-9 codes annually for accuracy and implements changes. (10%)

Assists physicians and other providers with questions and problems related to coding, documentation and billing.  (10%)     


Works with other departments regarding coding interface/policy/process enhancements, development or changes, as well as implementation of these functions throughout the organization.  (10%)

Creates appropriate policies, procedures and guidelines ensuring compliance with CMS, AMA &L.A. Care's compliance department and policies. (5%) 

Maintains active coding certification and keeps up to date on coding guidelines and reimbursement reporting requirements. Brings identified concerns to Manager for resolution.  (10%)


Performs other duties as assigned.  (10%)

Education Required
Associate's Degree
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Bachelor's Degree

At least 4 years of coding experience with emphasis on Medicare and Medi-Cal requirements in a Managed Care environment. 


Prior work experience in the healthcare field specifically related to coding and/or medical billing and compliance. 


Experience and knowledge of accurate ICD-9 and Medicare HCC coding.


Advanced knowledge of ICD-9, CPT and HCPCS coding, medical terminology and regulatory requirements.
Medical terminology, human anatomy/physiology. 


Medicare, Medi-Cal coding guidelines.


Familiarity of state and federal laws, professional standards, and accreditation standards.


Training program development and presentation skills.


Medical chart auditing.

Licenses/Certifications Required
Medical Coding Certification
Active & Current Driver's License, with a clean record and Auto Insurance Required
Licenses/Certifications Preferred
Required Training
Additional Information

This position will involve up to 25-35% travel –coder will be in the field at physician offices.


L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)

Nearest Major Market: Los Angeles

Job Segment: Medical, Physiology, Medicare, Medical Coding, Healthcare