Lead HCC Coding Specialist

🕒 May 22

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $72.7k - $116.6k / year

⏰ Full Time

🟠 Senior

🏥 Medical Billing and Coding

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

💰 $5M Grant on 2021-05

Healthcare Insurance • Non-profit • Social Impact

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• 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