The Hierarchical Condition Category (HCC) Coding Specialist at Highmark Health plays a crucial role in delivering value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and the Affordable Care Act (ACA). This position requires a deep understanding of HCC coding, medical coding, clinical terminology, and anatomy/physiology, as well as familiarity with the Centers for Medicare and Medicaid Services (CMS) coding guidelines and Risk Adjustment Data Validation (RADV) Audits. The specialist will work closely with physicians, team members, Quality, Compliance, and leadership to ensure high-quality and accurate risk adjustment coding. The role involves supporting Remote Patient Monitoring (RPM) risk adjustment projects to comply with CMS requirements by analyzing physician documentation and translating it into ICD10 diagnoses and HCC disease categories. The specialist will also engage in various projects, including both retro and prospective coding for MA, ESRD, and ACA HCC Models, while maintaining adherence to CMS guidelines and Highmark's policies. Additionally, the specialist will assist with regulatory audits, participate in educational meetings, and contribute to process improvements within the department. This position is remote office-based, requiring occasional travel to various work sites. The specialist will be expected to lift up to 10 pounds constantly and occasionally lift up to 25 pounds. The job description emphasizes the importance of compliance with ethical and legal standards, including HIPAA regulations, and the need for employees to protect confidential customer information. Overall, the HCC Coding Specialist is integral to ensuring accurate coding and compliance within the healthcare system, ultimately benefiting the health plan and its members.