Lead HCC Coding Specialist

Role Overview

• Deliver value to the Health Plan and its beneficiaries enrolled in risk-adjusted government programs through HCC coding, medical coding, clinical terminology and anatomy/physiology
• Conduct quality assurance (QA) review of internal coding team members
• Provide coding education to team
• Evaluate HCC coding questions and independently renders guidance on appropriate coding determinations
• Supports RADV audits
• Specializes in performing second level review of HCC validation
• Prepares documentation and coversheets for upload to regulatory body and/or independent auditor
• Analyzes results
• Develop presentations to improve provider documentation and accuracy
• Conducts Quality Assurance (QA) reviews on internal coders
• Guides coding decision making adhering to CMS Guidelines for Coding and Highmark’s Policy and Procedures

Requirements

• Associate's degree in medical billing/coding, health insurance, healthcare or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree
• 5 years of HCC risk adjustment coding experience
• 7 years of HCC risk adjustment coding experience preferred
• 3 years of RADV audit experience
• 3 years of Coding QA experience
• 3 years of LPN or RN experience
• 1 years of Management or leadership
• Certified Professional Coder (CPC) or Certified Risk Coder (CRC) or Certified Coding Specialist (CCS) or Registered Health Information Technician (RHIT) required

Benefits

• Health insurance
• 401(k) matching
• Paid time off
• Flexible work arrangements
• Professional development opportunities