Hierarchical Condition Category (HCC) Coding Specialist

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.

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; Maintains RPM coding accuracy and productivity requirements; Assists with Regulatory Audits by performing first coding review and ranking of charts; Participates on ad-hoc projects per direction of Leadership; Engages in RPM Coding educational meetings and annual coding Summit

Requirements

3 years HCC coding and/or coding and billing; Certified Professional Coder (CPC) or Certified Risk Coder (CRC) or Certified Coding Specialist (CCS) or Registered Health Information Technician (RHIT); Critical Thinking; Attention to Detail; Written and Oral Presentation Skills; Written Communications; Communication Skills; HCC Coding; MS Word, Excel, Outlook, PowerPoint; Microsoft Office Suite Proficient/ - MS365 & Teams

Nice to have

Associate degree in medical billing/coding, health insurance, healthcare or related field; 5 years HCC coding and/or coding and billing