HCC Coding Specialist
2 months ago
POSITION SUMMARY
The HCC Coding Specialist plays a crucial role in managing and training for Risk Adjustment HCC coding, ensuring seamless collaboration among healthcare providers, office personnel, and health plan representatives to meet organizational objectives.
KEY RESPONSIBILITIES
- Analyze medical records to identify, gather, evaluate, and document claims and encounter coding information relevant to Hierarchical Condition Categories (HCC).
- Conduct audits of provider documentation for CPT, ICD-9, and ICD-10 codes to ensure compliance with coding standards and CMS Risk Adjustment regulations.
- Assess HCC auditing procedures and offer insights and recommendations to enhance provider documentation and coding accuracy.
- Facilitate ongoing education for providers regarding HCC coding practices.
- Engage in process and quality improvement initiatives to enhance operational efficiency.
- Achieve productivity and quality benchmarks consistently.
- Review Comprehensive Annual Wellness Examination (CAPE) forms as part of the coding process.
- Perform additional duties as necessary to support the team.
EDUCATION & EXPERIENCE REQUIREMENTS
- Bilingual proficiency in Korean is preferred but not mandatory.
- A minimum of 2 years of experience in HCC coding is required.
- Certification as a Medical Coder, holding either CPC or CCS credentials.
- Familiarity with Medicare managed care practices.
- Ability to foster positive professional relationships with providers and IPAs.
- Exceptional verbal and written communication skills.
- Strong organizational capabilities.
- Proven analytical and problem-solving skills to address challenges in obtaining and validating accurate HCC information.
- Capacity to work independently as well as collaboratively within a team.
- Must maintain an accuracy standard of 95% or higher.
- Proficient in Microsoft Outlook, Word, Excel, and PowerPoint.
- Experience with Electronic Medical Records (EMR) systems.
- Possession of a reliable vehicle and a clean, unrestricted driver's license.
- Willingness to travel as required.
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