Hierarchical Condition Category (HCC) Coding Specialist
About the position
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.
Responsibilities
Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD).
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Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models.
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Works independently in various coding applications and electronic medical record systems to support departmental goals.
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Adheres to CMS Guidelines for Coding and Highmark's Policy and Procedures to guide HCC coding decision making.
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Maintains RPM coding accuracy and productivity requirements.
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Assists with Regulatory Audits by performing first coding review and ranking of charts.
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Builds partnerships and works within coding teams and internal partners critical to HCC coding.
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Participates on ad-hoc projects per the direction of Leadership to address the needs of the department.
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Provides recommendations for process improvements and efficiencies.
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Engages in RPM Coding educational meetings and annual coding Summit.
Requirements
3 years HCC coding and/or coding and billing experience required.
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Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT) certification required.
Nice-to-haves
5 years HCC coding and/or coding and billing experience preferred.
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Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.
Benefits
Remote work flexibility
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Competitive salary range from $26.49 to $41.03 per hour
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Opportunities for professional development and training
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Comprehensive health benefits
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Supportive work environment promoting diversity and inclusion
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