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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

• 3 years of medical billing/coding, health insurance, and/or healthcare experience

Preferred

• 1 year of HCC risk adjustment coding

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

• Associates degree in medical billing/coding, health insurance, healthcare, or related field.

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• 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)

Preferred

• None

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: J239261