Hierarchical Condition Category (HCC) Coding Specialist
About The Position
This role delivers risk adjustment coding value to the Health Plan and beneficiaries enrolled in government programs, including Medicare Advantage (MA), the Affordable Care Act (ACA), and End Stage Renal Disease (ESRD). The specialist analyzes physician documentation and interprets it into ICD-10 diagnoses and HCC disease categories, supporting Remote Patient Monitoring (RPM) risk adjustment projects in compliance with CMS requirements. The role also contributes to documentation improvement, provider education, report analysis, and process improvement. The specialist works with physicians, coding teams, Quality, Compliance, Enterprise partners, and leadership to support accurate risk adjustment coding. The position flexes between retrospective and prospective coding projects and different HCC models, using coding applications and electronic medical record systems. It also supports regulatory audits through initial chart review and ranking, participates in ad hoc projects, and attends RPM coding education meetings and the annual coding Summit.
Requirements
- At least 3 years of experience in HCC coding and/or coding and billing.
- One of the following certifications is required: 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 presentations, written communications, communication, and HCC coding.
- Proficiency with Microsoft Office, including 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 experience in HCC coding and/or coding and billing.
Responsibilities
- Perform HCC coding for MA, ACA, and ESRD projects, including retrospective and prospective projects and different 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 performing the initial coding review and ranking charts.
- Build partnerships and work with coding teams and internal partners involved in HCC coding.
- Participate in ad hoc projects at leadership’s direction 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
