Hierarchical Condition Category (HCC) Coding Specialist

at Highmark Health in Boise, Idaho, United States

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act ( ACA ), using skills including but not limited to Hierarchical Condition Category ( HCC ) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services ( CMS ) coding guidelines, and Risk Adjustment Data Validation ( RADV ) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient Monitoring ( RPM ) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements.

ESSENTIAL RESPONSIBILITIES

+ Performs HCC coding on projects for MA, ACA , and End Stage Renal Disease ( ESRD ). Flexes between coding projects, including Retro and Prospective, with different MA, ESRD , and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals. Adheres to CMS Guidelines for Coding and Highmarks Policy and Procedures to guide HCC coding decision making. Maintains RPM coding accuracy and productivity requirements.

+ Assists with Regulatory Audits by performing first coding review and ranking of charts. Build partnerships and work within coding teams and internal partners critical to HCC coding.

+ Participates on ad-hoc projects per the direction of Leadership to address the needs of the department. Provides recommendations for process improvements and efficiencies.

+ Engages in RPM Coding educational meetings and annual coding Summit.

+ Other duties as assigned.

EDUCATION

Required

+ None

Substitutions

+ None

Preferred

+ Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.

EXPERIENCE

Required

+ 3 years HCC coding and/or coding and billing

Preferred

+ 5 years HCC coding and/or coding and billing

LICENSES or CERTIFICATIONS

Required (any of the following)

+ Certified Professional Co