Hierarchical Condition Category (HCC) Coding Specialist

Highmark Health; Northern (KY); On-site; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. seeks an HCC Coding Specialist to support Risk Adjustment programs (MA/ACA/ESRD) by applying CMS guidelines, coding accuracy, and documentation improvement.

This remote, full-time role collaborates with physicians, Quality, Compliance, and IT teams. Ideal candidate has at least 3 years of HCC coding experience, familiarity with ICD-10 and RADV audits, and an associate degree in medical billing/coding or related field.

Qualifications

• 3 years HCC coding and/or coding and billing experience.
• Familiarity with ICD-10 and RADV audits is preferred.
• Associate degree in medical billing/coding or related field preferred.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects.
• Adheres to CMS guidelines and Highmark policies.
• Supports RPM coding accuracy and productivity targets.
• Assists with regulatory audits and chart reviews.
• Collaborates with physicians, Quality, Compliance and IT teams.

Skills

HCC Coding

Attention to Detail

Written and Oral Presentation Skills

Communication Skills

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

Associate degree in medical billing/coding

Tools

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Job description

## Hierarchical Condition Category (HCC) Coding SpecialistApplyremote type: Remotelocations: PA, Working at Home - Pennsylvania: MD, Working at Home - Maryland: WA, Working at Home - Washington: NC, Working at Home - N Carolina: LA, Working at Home - Louisianatime type: Full timeposted on: Posted Todayjob requisition id: J285910## **Company :**Highmark Inc.## **Job Description :****JOB SUMMARY**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, and 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, and identifying process improvements.**ESSENTIAL RESPONSIBILITIES*** Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals. Adheres to CMS Guidelines for Coding and Highmark’s Policy and Procedures to guide HCC coding decision making. Maintains RPM coding accuracy and productivity requirements.* Assists with Regulatory Audits by performing first coding review and ranking of charts. Build partnerships and work within coding teams and internal partners critical to HCC coding.* Participates on ad-hoc projects per the direction of Leadership to address the needs of the department. Provides recommendations for process improvements and efficiencies.* Engages in RPM Coding educational meetings and annual coding Summit.* Other duties as assigned.**EDUCATION****Required*** None**Substitutions*** None**Preferred*** Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.**EXPERIENCE****Required*** 3 years HCC coding and/or coding and billing**Preferred*** 5 years HCC coding and/or coding and billing**LICENSES or CERTIFICATIONS****Required** (any of the following)* Certified Professional Coder (CPC)* Certified Risk Coder (CRC)* Certified Coding Specialist (CCS)* Registered Health Information Technician (RHIT)**Preferred*** None**SKILLS*** Critical Thinking* Attention to Detail* Written and Oral Presentation Skills* Written Communications* Communication Skills* HCC Coding* MS Word, Excel, Outlook, PowerPoint* Microsoft Office Suite Proficient/ - MS365 & Teams**Language (Other than English):**None**Travel Requirement:**0% - 25%**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS****Position Type**Remote Office-basedTeaches / trains others regularlyOccasionallyTravel regularly from the office to various work sites or from site-to-siteOccasionallyWorks primarily out-of-the office selling products/services (sales employees)NeverPhysical work site requiredNoLifting: up to 10 poundsConstantlyLifting: 10 to 25 poundsOccasionallyLifting: 25 to 50 poundsRarely***Disclaimer:*** *The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. **Compliance Requirement**: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.* *As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.***Pay Range Minimum:**$27.02**Pay Range Maximum:**$41.85*Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.*