Hierarchical Condition Category (HCC) Coding Specialist

Highmark Health; Washington (NC); On-site; USD 60,000 - 80,000; Full time

Job summary

Highmark Health is looking for a Hierarchical Condition Category (HCC) Coding Specialist to deliver value to healthcare plans and beneficiaries. The role requires expertise in HCC coding, clinical terminology, and adherence to CMS guidelines.

The successful candidate will support various coding projects and assist with audits, while working collaboratively with teams to ensure compliance and accuracy. Preferred qualifications include an associate degree related to healthcare and relevant certifications. This position is remote, providing flexibility in location.

Qualifications

• 3 years of HCC coding and/or coding and billing experience required.
• Certified Professional Coder (CPC), Certified Risk Coder (CRC), or equivalent certification required.
• Strong proficiency in MS Word, Excel, Outlook, and PowerPoint.

Responsibilities

• Perform HCC coding for various projects including MA, ACA, and ESRD.
• Assist with Regulatory Audits by performing coding reviews.
• Engage in RPM Coding educational meetings and recommended coding practices.

Skills

Hierarchical Condition Category (HCC) Coding

Critical Thinking

Attention to Detail

Communication Skills

Microsoft Office Suite

Education

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

Job description

Hierarchical Condition Category (HCC) Coding SpecialistSkip to main contentThank you for your interest in employment at a Highmark Health company. Highmark Health uses an online application process. If you participate in the online application process through this Workday site, your personal information will be collected, including but not limited to data such as your resume and resume content, education, contact information, address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide. As part of the online application process, we will provide details such as how we will use the data that we collect and where such information is processed. We will also ask for your consent to use the data for purposes contained in the Highmark Health Data Protection Statement and the GDPR Data Protection Consent for Job Applicants, and for all other permissible purposes.# CareersHierarchical Condition Category (HCC) Coding Specialist page is loaded## 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: J283469## **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.*