Senior Hierarchical Condition Category (HCC) Coding Specialist

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

📋 Description

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

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

• Assist with risk adjustment projects in alignment with CMS requirements.

• Perform medical record reviews and identify opportunities for enhancing provider documentation and coding precision.

• Carry out quality assessments of high-risk and incremental HCCs.

• Collaborate on data gathering, provider education and outreach, and coding quality assurance.

• Create and deliver process improvement and training initiatives.

• Analyze coding patterns among providers and provider groups, and conduct external presentations.

• Act as a primary contact for provider offices and offer supplementary training.

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

• Contribute to RADV audit coding reviews and preparation of chart submissions.

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

• Mentor new employees and colleagues while developing onboarding and training resources.

• Assist with external vendor quality assessments and report findings.

⛳️ Requirements

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

• Three years of experience in HCC risk adjustment coding.

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

• Strong critical thinking skills.

• Exceptional attention to detail.

• Excellent verbal and written communication abilities, including presentation skills.

• Capability to manage projects to successful completion.

• Strong interpersonal skills.

• Proficient in identifying and resolving issues.

• Ability to thrive in a fast-paced, collaborative environment with minimal supervision.

• Extensive understanding of medical terminology and capability to research coding-related inquiries.

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

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

• Adherence to HIPAA, data security protocols, company policies, and applicable laws.

• Travel requirement: 0%–25%.

🏝️ Benefits

• Comprehensive health coverage.

• Retirement savings plan with company match.

• Paid time off and holidays.

• Professional development opportunities.

• Supportive work environment.