Senior HCC Coding & RADV Audit Lead

Highmark; United States; On-site; USD 75,000 - 95,000; Full time

Job summary

Highmark is seeking an experienced Coding Specialist in the United States to enhance quality in risk-adjusted government programs through expert HCC coding, QA reviews, and clinical analysis.

This role involves conducting audits, mentoring colleagues, and ensuring compliance with CMS guidelines. Candidates should have extensive coding knowledge and strong analytical skills. The position offers opportunities for professional development and collaboration with various healthcare partners.

Qualifications

• 5 years of HCC risk adjustment coding experience required.
• Certified Professional Coder (CPC) or equivalent certification.
• Ability to analyze coding-related questions objectively.

Responsibilities

• Conducts quality assurance reviews on internal coders.
• Completes government audits and prepares documentation.
• Mentors new hires and develops training materials.
• Analyzes coding trends and collaborates with provider entities.

Skills

Critical Thinking

Attention to Detail

Strong Verbal and Written Communication Skills

Interpersonal Skills

Microsoft Office Suite Proficient

Education

Associate’s degree in medical billing/coding or related field

Tools

Microsoft Office Suite

Job description

Highmark is seeking an experienced Coding Specialist in the United States to enhance quality in risk-adjusted government programs through expert HCC coding, QA reviews, and clinical analysis.

This role involves conducting audits, mentoring colleagues, and ensuring compliance with CMS guidelines. Candidates should have extensive coding knowledge and strong analytical skills. The position offers opportunities for professional development and collaboration with various healthcare partners.