HCC Coding Specialist

This is a fully remote position, open to applicants in Louisiana, +4 more states.

📋 Description

• Provide value to the Health Plan and the beneficiaries enrolled in risk-adjusted government programs, including Medicare Advantage and Affordable Care Act initiatives.

• Execute HCC coding for projects related to Medicare Advantage, ACA, and End Stage Renal Disease.

• Adapt between Retro and Prospective coding projects across various HCC models.

• Examine physician documentation and translate it into ICD-10 diagnoses along with HCC disease categories.

• Assist in Remote Patient Monitoring risk-adjustment projects while adhering to CMS requirements.

• Abide by CMS coding guidelines and Highmark's policies and procedures.

• Ensure RPM coding accuracy and meet productivity standards.

• Aid in regulatory audits by carrying out initial coding reviews and ranking charts.

• Foster partnerships and collaborate within coding teams and with internal stakeholders.

• Engage in ad-hoc departmental projects.

• Suggest process enhancements and efficiencies.

• Take part in RPM coding educational sessions and the annual coding Summit.

• Carry out additional duties as assigned.

⛳️ Requirements

• A minimum of 3 years of experience in HCC coding and/or coding and billing is required.

• Possession of CPC, CRC, CCS, or RHIT certification is mandatory.

• An Associate degree in medical billing/coding, health insurance, healthcare, or a related field is preferred.

• Strong critical thinking skills.

• Excellent attention to detail.

• Proficient written and oral presentation abilities.

• Effective written communication skills.

• Strong overall communication skills.

• Proficiency in HCC coding.

• Skilled in MS Word, Excel, Outlook, PowerPoint, Microsoft Office Suite, MS365, and Teams.

• Willingness to travel 0%–25% of the time.

• Must adhere to CMS coding guidelines and Highmark policies and procedures.

• Must follow HIPAA, data security protocols, the company Code of Business Conduct, and applicable laws, regulations, and training requirements.

• Ability to lift up to 10 pounds constantly, 10–25 pounds occasionally, and 25–50 pounds rarely.

🏝️ Benefits

• Flexible remote work arrangement.

• Involvement in RPM Coding educational meetings.

• Access to the annual coding Summit.

• Opportunities for professional development through provider education and documentation improvement activities.