Associate Hierarchical Condition Category (HCC) Coding Specialist
Company: Highmark Health
Location: Salem
Posted on: November 20, 2023
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Job Description:
Company :
Highmark Inc.
Job Description :
JOB SUMMARY
This job will deliver value to the Health Plan and its
beneficiaries enrolled in Risk Adjusted government programs such as
Medicare Advantage (MA) and/or Affordable Care Act (ACA) using
skills including but not limited to Hierarchical Condition Category
(HCC) Coding, medical coding, clinical terminology and
anatomy/physiology, and Centers for Medicare and Medicaid Services
(CMS) coding guidelines. Works closely with team members, 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 ICD-10
diagnoses and HCC disease categories.
ESSENTIAL RESPONSIBILITIES
Performs HCC coding on projects for MA, ACA, or End Stage Renal
Disease (ESRD) through the assignment of appropriate ICD-10
diagnosis codes under the direction of management; may flex between
coding projects with different MA, ESRD, or ACA HCC Models.
(50%)
Adheres to CMS Guidelines for Coding and Highmark's Policy and
Procedures to guide HCC coding decision making.Achieves and
maintains coding productivity and quality accuracy metrics set by
the management team. May assist with Regulatory Audits by
performing first coding review and ranking of charts. Build
partnerships and work within coding teams and internal partners
critical to HCC coding. (20%)
Participates in ad-hoc projects per the direction of leadership to
address the needs of the department.Provides recommendations for
process improvements and efficiencies. (10%)
Engages in coding educational meetings and annual coding summit.
(10%)
Works in various coding applications to support departmental goals.
(10%)
Other duties as assigned or requested.
--- EXPERIENCE
Required
Preferred
SKILLS
Critical Thinking
Attention to Detail
Communication Skills
Medical Coding or Billing
MS Word, Excel, Outlook, PowerPoint
Microsoft Office Suite Proficient/ - MS365 & Teams
EDUCATION
Required
Preferred
LICENSES or CERTIFICATIONS
Required
Preferred
Language (Other than English) :
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office- or Remote-based
Teaches / trains others
Occasionally
Travel from the office to various work sites or from
site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales
employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Occasionally
Disclaimer: The job description has been designed to indicate the
general nature and essential duties and responsibilities of work
performed by employees within this job title. It may not contain a
comprehensive inventory of all duties, responsibilities, and
qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal
standards and behavioral expectations as set forth in the code of
business conduct and company policies .
_As a component of job responsibilities, employees may have access
to covered information, cardholder data, or other confidential
customer information that must be protected at all times.--- In
connection with this, all employees must comply with both the
Health Insurance Portability Accountability Act of 1996 (HIPAA) as
described in the Notice of Privacy Practices and Privacy Policies
and Procedures as well as all data security guidelines established
within the Company's Handbook of Privacy Policies and Practices and
Information Security Policy.---_
Furthermore, it is every employee's responsibility to comply with
the company's Code of Business Conduct. This includes but is not
limited to adherence to applicable federal and state laws, rules,
and regulations as well as company policies and training
requirements.
Pay Range Minimum:
$20.80
Pay Range Maximum:
$37.43
Base pay is determined by a variety of factors including a
candidate's qualifications, experience, and expected contributions,
as well as internal peer equity, market, and business
considerations. The displayed salary range does not reflect any
geographic differential Highmark may apply for certain locations
based upon comparative markets.
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 their race, color, age, religion,
sex, national origin, sexual orientation/gender identity or any
other category protected by applicable federal, state or local law.
Highmark Health and its affiliates take affirmative action to
employ and advance in employment individuals without regard to
race, color, age, religion, sex, national origin, sexual
orientation/gender identity, protected veteran status or
disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected
Veterans/Disabled/Sexual Orientation/Gender Identity (
https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf
)
We endeavor to make this site accessible to any and all users. If
you would like to contact us regarding the accessibility of our
website or need assistance completing the application process,
please contact number below.
For accommodation requests, please contact HR Services Online at
HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and
Applicants Notice
Req ID: J234215
Keywords: Highmark Health, Salem , Associate Hierarchical Condition Category (HCC) Coding Specialist, Other , Salem, Oregon
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