Hierarchical Condition Category (HCC) Coding Specialist

Highmark Health•Carolina, PA

17h•Remote

About The Position

This job delivers value to the Health Plan and beneficiaries enrolled in risk-adjusted government programs, including Medicare Advantage (MA) and the Affordable Care Act (ACA). The specialist applies HCC and medical coding knowledge, clinical terminology, anatomy and physiology, CMS coding guidelines, and Risk Adjustment Data Validation (RADV) audit practices. The role works with physicians, team members, Quality, Compliance, Enterprise partners, and leadership to support accurate risk adjustment coding. It also supports Remote Patient Monitoring (RPM) risk-adjustment projects by analyzing physician documentation and translating it into ICD-10 diagnoses and HCC disease categories. Other objectives include documentation improvement, provider education, report analysis, and process improvement. The position is remote and office-based. It may involve occasional teaching or training and occasional travel from the office to work sites. Travel requirement is 0%–25%.

Requirements

At least 3 years of HCC coding and/or coding and billing experience.
At least one of the following certifications or credentials: Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT).
Skills in critical thinking, attention to detail, written and oral presentation, written communication, communication, and HCC coding.
Proficiency with Microsoft Office, including MS Word, Excel, Outlook, PowerPoint, Microsoft 365, and Teams.

Nice To Haves

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

Responsibilities

Perform HCC coding for Medicare Advantage, ACA, and End Stage Renal Disease (ESRD) projects.
Flex between retrospective and prospective coding projects and different MA, ESRD, and ACA HCC models.
Work independently in coding applications and electronic medical record systems to support departmental goals.
Follow CMS coding guidelines and Highmark policies and procedures when making HCC coding decisions.
Meet RPM coding accuracy and productivity requirements.
Assist with regulatory audits by conducting initial coding reviews and ranking charts.
Build partnerships and work with coding teams and internal partners.
Participate in ad hoc projects as directed by leadership.
Recommend process improvements and efficiencies.
Participate in RPM coding educational meetings and the annual coding Summit.
Perform other duties as assigned.
Protect confidential customer information and comply with HIPAA, data-security guidelines, the Code of Business Conduct, applicable laws, company policies, and training requirements.