[Hiring] Lead 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 (MA and ACA) through:

• Hierarchical Condition Category (HCC) coding
• Medical coding
• Clinical terminology and anatomy/physiology
• CMS coding guidelines
• Support of Risk Adjustment Data Validation (RADV) audits

The incumbent supports RADV audits, specializing in:

• Performing second level review of HCC validation
• Researching outstanding HCCs
• Preparing documentation and coversheets for upload to regulatory body and/or independent auditor
• Analyzing results

May also be responsible for high-priority and key strategic provider entities and/or anchor partners to:

• Analyze and evaluate coding trends
• Proactively identify issues and present solutions to internal leadership and external entities
• Lead activities with provider entities

Works closely with colleagues, leadership, enterprise matrix partners (such as quality and/or compliance), and/or physicians to:

• Identify and deliver high quality and accurate risk adjustment coding
• Support all risk adjustment projects to comply with CMS requirements
• Analyze physician documentation and interpret into ICD-10 diagnoses and HCC disease categories

Supports other key objectives to drive capture of accurate risk adjustment coding including:

• Documentation improvement
• Provider education
• Report analysis
• Identification of process improvements

Mentors new hires, creates training materials, and delivers training via in-person, virtual, or webinar forums. Required cross-team collaboration for all team projects, including provider outreach, education, and analysis.

Qualifications

• Associate's degree in medical billing/coding, health insurance, healthcare or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree
• Bachelor's degree in medical billing/coding, health insurance, healthcare or related field (preferred)

Requirements

• 5 years of HCC risk adjustment coding experience (required)
• 7 years of HCC risk adjustment coding experience (preferred)
• 3 years of RADV audit experience (preferred)
• 3 years of Coding QA experience (preferred)
• 3 years of LPN or RN experience (preferred)
• 1 year of Management or leadership experience (preferred)

Benefits

• Pay Range Minimum: $72,700.00
• Pay Range Maximum: $116,600.00

Company Description

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at [email protected]