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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 …
Skills: HCC Coding, Medical Coding, Clinical Terminology, Anatomy, Physiology
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Washington, District of Columbia, United States • Remote Solely
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The HCC Coding Specialist will perform HCC coding for various risk adjustment programs and ensure compliance with CMS guidelines. They will also support documentation improvement and provider education initiatives.
Candidates are required to have at least 3 years of HCC coding experience, with a preferred 5 years. A certification such as CPC, CRC, CCS, or RHIT is also required.
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
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
Preferred
LICENSES or CERTIFICATIONS
Required (any of the following)
Certified Professional Coder (CPC)
Certified Risk Coder (CRC)
Certified Coding Specialist (CCS)
Registered Health Information Technician (RHIT)
Preferred
None
SKILLS
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Remote Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Occasionally
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at [email protected]
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Our mission is to create a remarkable health experience, freeing people to be their best.
Allegheny Health Network is an integrated health care delivery system serving the greater Western Pennsylvania region. More than 2,600 physicians and 21,000 employees serve the system's 16 hospitals as well as its ambulatory medical and surgery centers, Health + Wellness Pavilions, and hundreds of physician practice locations. AHN is a proud part of Highmark Health.
Offices: 4800 Friendship Ave, Pittsburgh, Pennsylvania 15224, US · 2570 Haymaker Rd, Monroeville, Pennsylvania 15146, US · 320 E North Ave, Pittsburgh, Pennsylvania 15212, US · 12351 Perry Hwy, Wexford, Pennsylvania 15090, US · 1301 Carlisle St, Natrona Heights, Pennsylvania 15065, US
