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Hierarchical Condition Category Specialist
2 months ago
Job Summary:
This role will deliver value to the Health Plan and its beneficiaries by utilizing skills in Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology, and anatomy/physiology. The successful candidate will work closely with physicians, team members, Quality, Compliance, and partners at Enterprise and leadership to identify and deliver high-quality and accurate risk adjustment coding.
Key Responsibilities:
- Perform HCC coding on projects for Medicare Advantage, Affordable Care Act, and End Stage Renal Disease, adhering to CMS Guidelines and Highmark's Policy and Procedures.
- Assist with Regulatory Audits by performing first coding review and ranking of charts, building partnerships with coding teams and internal partners.
- Participate in ad-hoc projects to address departmental needs, providing recommendations for process improvements and efficiencies.
- Engage in Risk Adjustment Coding educational meetings and annual coding Summits.
Requirements:
- 3 years of experience in HCC coding and/or coding and billing.
- Associate degree in medical billing/coding, health insurance, healthcare, or a related field (preferred).
- Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT) certification (required).
Preferred Qualifications:
- 5 years of experience in HCC coding and/or coding and billing.
Skills:
- Critical Thinking
- Attention to Detail
- Written and Oral Presentation Skills
- Written Communications
- Communication Skills
- HCC Coding
- Microsoft Office Suite Proficient (MS365 & Teams)
Language: English
Travel Requirement: 0% - 25%
Physical, Mental Demands, and Working Conditions:
- Remote Office-based
- Occasional travel from the office to various work sites or from site-to-site
- Lifting: up to 10 pounds (constant)
- Lifting: 10 to 25 pounds (occasional)
Pay Range: $26.49 - $41.03
Equal Employment Opportunity: Highmark Health and its affiliates are equal opportunity employers and prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity, or any other category protected by applicable federal, state, or local law.
