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About the Role
This role delivers value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs like Medicare Advantage (MA) and Affordable Care Act (ACA). It utilizes skills in HCC Coding, medical coding, clinical terminology, anatomy/physiology, CMS coding guidelines, and RADV Audits. The position involves close collaboration with physicians, team members, Quality, Compliance, Enterprise partners, and leadership to ensure accurate risk adjustment coding. It also supports Remote Patient Monitoring (RPM) projects to comply with CMS requirements by analyzing physician documentation and interpreting it into ICD10 diagnoses and HCC disease categories. Additionally, it drives the capture of correct Risk Adjustment coding through documentation improvement, provider education, report analysis, and process improvement identification.
Responsibilities
- Performs HCC coding on projects for MA, ACA, and ESRD, adapting to different coding models and working independently in various coding applications and EMR systems.
- Adheres to CMS Guidelines and Highmark’s Policy and Procedures for HCC coding decisions.
- Maintains RPM coding accuracy and productivity requirements.
- Assists with Regulatory Audits by performing first coding review and ranking of charts.
- Builds partnerships and collaborates within coding teams and with internal partners critical to HCC coding.
- Participates in ad-hoc projects as directed by Leadership to meet departmental needs.
- Provides recommendations for process improvements and efficiencies.
- Engages in RPM Coding educational meetings and the annual coding Summit.
- Performs other duties as assigned.
Requirements
- 3 years of HCC coding and/or coding and billing experience required.
- Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT) required.
- Proficient in MS Word, Excel, Outlook, PowerPoint.
- Proficient with Microsoft Office Suite (MS365 & Teams).
- Adheres to ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
- Complies with HIPAA, Privacy Policies and Procedures, and data security guidelines.
- Complies with the company’s Code of Business Conduct, including applicable federal and state laws, rules, and regulations, and company policies and training requirements.
Skills
- HCC Coding
- Medical coding
- Clinical terminology
- Anatomy/physiology
- CMS coding guidelines
- RADV Audits
- Critical Thinking
- Attention to Detail
- Written and Oral Presentation Skills
- Written Communications
- Communication Skills
Location
- Remote
Work Type
- Remote
- Office-based
Experience Level
- 3 years
- 5 years
Education Level
- Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.
Salary/Compensations
- $27.02
- $41.85
About the Company
- Highmark Inc. is a health insurance company.
- 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.
Equal Opportunity
- 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.