Lead Hierarchical Condition Category (hcc) Coding Specialist - (remote)
Highmark Health
Remote, US
Base: $72,700.00 - $116,600.00; bonus/equity: not ...
Fully remote
5 years hcc risk adjustment coding experience
Cms coding guidelines expertise
Quality assurance review of internal coders
Highmark Health is seeking a Lead Hierarchical Condition Category (HCC) Coding Specialist to support their Enhanced Community Care Management programs. This fully remote role involves overseeing HCC coding accuracy, conducting quality assurance reviews, and providing education to internal teams, as well as engaging with clinical providers to improve documentation
Job Summary
This role delivers value to Enhanced Community Care Management programs through expert Hierarchical Condition Category coding and medical terminology application.
The incumbent conducts quality assurance reviews, supports RADV audits, and leads educational initiatives for both internal teams and external providers.
Candidates must possess extensive knowledge of CMS guidelines to ensure accurate risk adjustment coding and compliance with regulatory requirements.
Matching Summary
Match Score: 85
Highmark Health is seeking a Lead Hierarchical Condition Category (HCC) Coding Specialist to support their Enhanced Community Care Management programs. This fully remote role involves overseeing HCC coding accuracy, conducting quality assurance reviews, and providing education to internal teams, as well as engaging with clinical providers to improve documentation.
Salary
Base: $72,700.00 - $116,600.00; Bonus/Equity: Not specified; Benefits: Not specified
Skills & Requirements
Must-have
5 years HCC risk adjustment coding experience
CMS coding guidelines expertise
Quality Assurance review of internal coders
RADV audit support and validation
ICD-10 diagnosis interpretation
Nice-to-have
Provider documentation improvement initiatives
Mentoring new hires and training delivery
Strategic provider entity engagement
Advanced analytics on coding trends
External presentation skills
Key Requirements
Associate's degree in medical billing/coding or related field
Certified Professional Coder (CPC), Certified Risk Coder (CRC), CCS, or RHIT
5 years of HCC risk adjustment coding experience
Experience working directly with clinical providers
Proficiency with AHA Coding Clinic and electronic medical record systems