Hierarchical Condition Category Coding Specialist

This is a fully remote position, open to applicants in Alabama, +44 more states.

📋 Description

• Conduct HCC coding for Medicare Advantage, Affordable Care Act, and End Stage Renal Disease initiatives.

• Switch between Retro and Prospective coding projects utilizing various MA, ESRD, and ACA HCC models.

• Operate independently within coding applications and electronic medical record systems.

• Adhere to CMS coding guidelines along with Highmark policies and procedures.

• Ensure RPM coding accuracy and meet productivity benchmarks.

• Support regulatory audits by conducting initial coding reviews and chart rankings.

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

• Engage in special departmental projects as needed.

• Suggest process enhancements and operational efficiencies.

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

• Execute additional duties as assigned.

⛳️ Requirements

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

• One of the following certifications is necessary: Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT).

• Knowledge of HCC coding principles.

• Familiarity with medical coding, clinical terminology, and anatomy/physiology.

• Understanding of CMS coding guidelines.

• Awareness of Risk Adjustment Data Validation (RADV) audit processes.

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

• Strong critical thinking skills.

• Exceptional attention to detail.

• Effective written and oral communication abilities.

• No language requirements beyond English.

🏝️ Benefits

• Opportunity for remote work.

• Travel requirement between 0% and 25%.