Hierarchical Condition Category (HCC) Coding Specialist

Job TitleThis job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.Essential ResponsibilitiesPerforms HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals. Adheres to CMS Guidelines for Coding and Highmark's Policy and Procedures to guide HCC coding decision making. Maintains RPM coding accuracy and productivity requirements.Assists with Regulatory Audits by performing first coding review and ranking of charts. Build partnerships and work within coding teams and internal partners critical to HCC coding.Participates on ad-hoc projects per the direction of Leadership to address the needs of the department. Provides recommendations for process improvements and efficiencies.Engages in RPM Coding educational meetings and annual coding Summit.Other duties as assigned.EducationRequired: NoneSubstitutions: NonePreferred: Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.ExperienceRequired: 3 years HCC coding and/or coding and billingPreferred: 5 years HCC coding and/or coding and billingLicenses or CertificationsRequired (any of the following): Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT)Preferred: NoneSkillsCritical Thinking, Attention to Detail, Written and Oral Presentation Skills, Written Communications, Communication Skills, HCC Coding, MS Word, Excel, Outlook, PowerPoint, Microsoft Office Suite Proficient/ – MS365 & TeamsLanguage (Other than English):NoneTravel Requirement:0% – 25%Physical, Mental Demands and Working ConditionsPosition Type: Remote Office-basedTeaches / trains others regularly: OccasionallyTravel regularly from the office to various work sites or from site-to-site: OccasionallyWorks primarily out-of-the office selling products/services (sales employees): NeverPhysical work site required: NoLifting: up to 10 pounds: ConstantlyLifting: 10 to 25 pounds: OccasionallyLifting: 25 to 50 pounds: RarelyCompliance RequirementThis job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.Pay RangePay Range Minimum: $27.02Pay Range Maximum: $41.85Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.For accommodation requests, please contact HR Services Online at View email address on click.appcast.io Consumer Privacy Act Employees, Contractors, and Applicants NoticeReq ID: J285910