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This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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3 years HCC coding and/or coding and billing. 5 years HCC coding and/or coding and billing. Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.
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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.
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Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). Adheres to CMS Guidelines for Coding and Highmark's Policy and Procedures to guide HCC coding decision making.
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Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding.
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Engages in RPM Coding educational meetings and annual coding Summit. Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements.
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Build partnerships and work within coding teams and internal partners critical to HCC coding. Maintains RPM coding accuracy and productivity requirements. Assists with Regulatory Audits by performing first coding review and ranking of charts.
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Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories.
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Certified Coding Specialist (CCS) 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.
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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.
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California Consumer Privacy Act Employees, Contractors, and Applicants Notice. 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.
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The Medical Billing and Coding Specialist is responsible for generating and processing medical claims within the Electronic Health Record (EHR) system, implementing payment arrangements, and liaising with various payor entities.
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Acts as liaison andintegrates systems related to patient registration, managed carereferrals/authorizations, charge capture, medical records,coding/billing, insurance companies, denials process, reimbursement teamactivities and collection department activities in order to maximizecharge capture and collections.
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What Success Looks Like In This Job The Medical Billing and Coding Specialist is responsible for generating and processing medical claims within the Electronic Health Record (EHR) system, implementing payment arrangements, and liaising with various payor entities.
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The Coding Auditor demonstrates expertise in coding and billing compliance while performing audits to determine billing integrity of professional and facility/technical fees including detection and correction of documentation, coding and billing errors and/or medical necessity of services billed.
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medical billing and coding jobs
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