Hierarchical Condition Category (HCC) Coding Specialist
About The Position
This role supports the Health Plan and beneficiaries enrolled in risk-adjusted government programs, including Medicare Advantage (MA) and the Affordable Care Act (ACA). The specialist uses HCC and medical coding knowledge, clinical terminology, anatomy and physiology, CMS coding guidelines, and familiarity with Risk Adjustment Data Validation (RADV) audits to support accurate risk adjustment coding. Working with physicians, coding teams, Quality, Compliance, Enterprise partners, and leadership, the specialist analyzes physician documentation and translates it into ICD-10 diagnoses and HCC disease categories for Remote Patient Monitoring (RPM) risk-adjustment projects. The role also supports documentation improvement, provider education, report analysis, process improvement, regulatory audits, and other departmental objectives. The position is remote and office-based.
Requirements
- At least 3 years of HCC coding and/or coding and billing experience.
- 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).
- Critical thinking and attention to detail.
- Written and oral presentation skills, written communication, and communication skills.
- HCC coding skills.
- Proficiency with Microsoft Office, including Word, Excel, Outlook, PowerPoint, MS365, 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 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 first coding reviews and ranking charts.
- Build partnerships and collaborate with coding teams and internal partners.
- Participate in ad hoc projects assigned by leadership and recommend process improvements and efficiencies.
- Participate in RPM coding educational meetings and the annual coding Summit.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
