Senior HCC Coding Specialist

This is a fully remote position, open to applicants in Alabama, +46 more states.

📋 Description

• Provide precise risk-adjustment coding values for beneficiaries of Medicare Advantage and the Affordable Care Act health plans.

• Evaluate physician documentation and translate it into ICD-10 diagnoses and HCC disease categories.

• Conduct reviews of medical records and outline documentation improvement opportunities.

• Execute quality assessments of high-risk and incremental HCCs.

• Collaborate on data acquisition, coding accuracy, provider education, and outreach initiatives.

• Design and deliver process enhancement and training programs.

• Complete analytics on coding trends for providers and provider groups, and present findings externally.

• Carry out HCC coding for MA, ACA, and ESRD projects across both Retro and Prospective models.

• Assist with RADV audit coding reviews, claims data analysis, chart ranking, and preparation of submissions.

• Implement assigned projects and engage in departmental ad-hoc projects.

• Guide new hires and colleagues while developing onboarding and training materials.

• Aid in external vendor quality assessments and document results.

⛳️ Requirements

• Associate's degree in medical billing/coding, health insurance, healthcare, or a related field, or equivalent experience and/or education as defined by the company in lieu of a degree.

• Minimum of 3 years’ experience in HCC risk adjustment coding.

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

• Experience in HCC coding for MA, ACA, and ESRD projects.

• Familiarity with CMS coding guidelines and Highmark policies and procedures.

• Understanding of medical terminology.

• Strong clinical knowledge of chronic illness diagnosis, treatment, and management.

• Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, PowerPoint, MS365, and Teams.

• Excellent critical thinking skills and attention to detail.

• Strong verbal and written communication skills, including the ability to present effectively.

• Capable of project management and problem-solving.

• Ability to work effectively in a collaborative setting with minimal supervision.

🏝️ Benefits

• Remote work arrangement.

• Travel requirement of 0%–25%.