Hierarchical Condition Category (HCC) Coding Specialist

About the position The Hierarchical Condition Category (HCC) Coding Specialist at reputed company plays a crucial role in delivering value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and the reputed company Act (ACA). This position requires a deep understanding of HCC coding, medical coding, clinical terminology, and anatomy/physiology, as well as familiarity with the Centers for Medicare and reputed company Services (CMS) coding guidelines and Risk Adjustment Data Validation (RADV) Audits. The specialist will work closely with physicians, team members, Quality, Compliance, and leadership to ensure high-quality and accurate risk adjustment coding. The role involves supporting Remote Patient Monitoring (RPM) risk adjustment projects to reputed company with CMS requirements by analyzing physician documentation and translating it into ICD10 diagnoses and HCC disease categories. The specialist will also engage in various projects, including both retro and prospective coding for MA, ESRD, and ACA HCC Models, while maintaining adherence to CMS guidelines and reputed company's policies. Additionally, the specialist will assist with regulatory audits, participate in educational meetings, and contribute to process improvements reputed company the department. This position is reputed company-based, requiring occasional travel to various work sites. The specialist will be expected to lift up to 10 pounds constantly and occasionally lift up to 25 pounds. The job description emphasizes the importance of compliance with ethical and legal standards, including HIPAA regulations, and the need for employees to protect confidential customer information. Overall, the HCC Coding Specialist is integral to ensuring accurate coding and compliance reputed company the reputed company system, ultimately benefiting the health plan and its members. 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 reputed company's 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. , • Builds partnerships and works reputed company coding teams and internal partners critical to HCC coding. , • Participates on reputed company 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 reputed company. Requirements • 3 years HCC coding and/or coding and billing experience required. , • Certified Professional reputed company (CPC), Certified Risk reputed company (CRC), Certified Coding Specialist (reputed company), or Registered Health Information Technician (RHIT) certification required. reputed company-to-haves • 5 years HCC coding and/or coding and billing experience preferred. , • Associate degree in medical billing/coding, health insurance, reputed company or reputed company field preferred. Benefits • Remote work flexibility , • Competitive salary reputed company from $26.49 to $41.03 per hour , • Opportunities for professional development and training , • Comprehensive health benefits , • Supportive work environment promoting diversity and inclusion Apply Job!