[Hiring] Hierarchical Condition Category (HCC) Coding Specialist @Highmark Health

Role Description

This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to:

• Hierarchical Condition Category (HCC) Coding
• Medical coding
• Clinical terminology and anatomy/physiology
• Centers for Medicare and Medicaid Services (CMS) coding guidelines
• Risk Adjustment Data Validation (RADV) Audits

Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including:

• Documentation improvement
• Provider education
• Analyzing reports
• Identifying process improvements

Qualifications

• Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.

Requirements

• 3 years HCC coding and/or coding and billing (Required)
• 5 years HCC coding and/or coding and billing (Preferred)
• Certified Professional Coder (CPC) (Required)
• Certified Risk Coder (CRC) (Required)
• Certified Coding Specialist (CCS) (Required)
• Registered Health Information Technician (RHIT) (Required)

Benefits

• Pay Range Minimum: $27.02
• Pay Range Maximum: $41.85

Physical, Mental Demands and Working Conditions

• Position Type: Remote Office-based
• Teaches / trains others regularly: Occasionally
• Travel regularly from the office to various work sites or from site-to-site: Occasionally
• Works primarily out-of-the office selling products/services: Never
• Physical work site required: No
• Lifting: up to 10 pounds: Constantly
• Lifting: 10 to 25 pounds: Occasionally
• Lifting: 25 to 50 pounds: Rarely