Hierarchical Condition Category Specialist

2 weeks ago


Phoenix, Arizona, United States Highmark Health Full time
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, 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.
  • Flex between coding projects, including retro and prospective, with different HCC models.
  • Adhere to CMS guidelines for coding and Highmark's policy and procedures.
  • Assist with regulatory audits by performing first coding review and ranking of charts.
  • Participate in ad-hoc projects to address departmental needs.
Requirements
  • 3 years of experience in HCC coding and/or coding and billing.
  • Associate degree in medical billing/coding, health insurance, or a related field.
  • Certified Professional Coder (CPC), Certified Risk Coder (CRC), or Certified Coding Specialist (CCS) certification.
Preferred Qualifications
  • 5 years of experience in HCC coding and/or coding and billing.
Skills
  • Critical thinking and attention to detail.
  • Written and oral presentation skills.
  • Communication skills.
  • HCC coding and Microsoft Office Suite proficiency.


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