Hierarchical Condition Category (HCC) Coding Specialist

Highmark Health•Washington, DC

1d•Remote

About The Position

This job delivers value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA). The role utilizes skills including 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. The specialist works closely with physicians, team members, Quality, Compliance, Enterprise partners, and leadership to identify and deliver high quality and accurate risk adjustment coding. The position supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with CMS requirements by analyzing physician documentation and interpreting it into ICD10 diagnoses and HCC disease categories. It also supports other key objectives to drive capture of correct Risk Adjustment coding, including documentation improvement, provider education, analyzing reports, and identifying process improvements.

Requirements

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

Nice To Haves

Associate degree in medical billing/coding, health insurance, healthcare or related field
5 years HCC coding and/or coding and billing

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.