HCC Coder

Presbyterian is seeking a HCC Coder

The Hierarchical Condition Category (HCC) Coder is responsible for reviewing professional fee services for PMG specialty providers or demonstrating coding expertise in a designated specialty area identified as a critical business need by PHS Coding Leadership. This role requires proficiency in ICD-9/10 CM and CPT-4 classification systems and strict adherence to hospital and departmental policies and procedures.

This is a Full Time position - Exempt: No
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Varied Days and Hours

Ideal candidate: A detail-oriented coding professional with specialized expertise, strong knowledge of classification systems, and a commitment to accuracy and complianc

• High school diploma/GED required.
• Must have any one of the following coding certifications at time of hire: CCS, CCS-P, CPC-H, or RHIT/RHIA with achievement of one of the coding credentials above within one year of hire.
• Three to five years experience as a coder required.
• Inpatient Coding experience preferred

• Demonstrates expertise in coding multiple service areas or a critical specialty.

• Reviews complete medical records and assigns CPT, ICD, and MS-DRG codes per guidelines.

• Uses multiple systems to research records and ensure timely, complete coding.

• Manages accounts receivable by locating missing documents and generating queries.

• Stays current on legal, regulatory, and coding updates across all relevant systems.

• Resolves pre-bill edits, denials, and coding issues for assigned accounts.

• Participates in training to maintain coding accuracy and medical knowledge.

• Communicates coding concerns to the Clinical Coding Manager.

• Maintains 95%+ accuracy and meets productivity standards.

• Fulfills continuing education requirements and performs additional duties as needed.

About Presbyterian Healthcare Services

Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities-like challenges, webinars, and screenings-with opportunities to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships.

Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.