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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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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.
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Description : JOB SUMMARYThis 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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Similar Jobs (2) Senior Decision Support Analyst remote type Hybrid locations 51 Locations time type Full time posted on Posted 30+ Days Ago Decision Support Analyst remote type Hybrid locations PA, Working at Home - Pennsylvania time type Full time posted on Posted 30+ Days Ago.
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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.
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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. Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.
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Office- or Remote-based. 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.
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Adheres to CMS Guidelines for Coding and Highmark's Policy and Procedures to guide HCC coding decision making. 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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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.
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1 year of HCC risk adjustment coding. Associates degree in medical billing/coding, health insurance, healthcare, or related field. Associate Hierarchical Condition Category (HCC) Coding Specialist. 3 years of medical billing/coding, health insurance, and/or healthcare experience.
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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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Works closely with team members, and leadership to identify and deliver high quality and accurate risk adjustment coding. Certified Risk Coder Apprentice (CRC-A) Certified Coding Specialist (CCS) Build partnerships and work within coding teams and internal partners critical to HCC coding.
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Certified Professional Coder Apprentice (CPC-A) OR Certified Professional Coder (CPC) OR Certified Risk Coder Apprentice (CRC-A) OR Certified Risk Coder (CRC) OR Certified Coding Specialist (CCS) OR Registered Health Information Technician (RHIT.
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Certified Risk Coder (CRC) Certified Professional Coder Apprentice (CPC-A) 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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remote job Company: Highmark Health
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