Hierarchical Condition Category (HCC) Coding Specialist
Core
Deliver value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs (Medicare Advantage, ACA) by performing HCC coding, medical coding, and Risk Adjustment Data Validation (RADV) Audits using clinical terminology and CMS guidelines.
Role type
HCC Coding Specialist
Builds
Risk adjustment coding for Medicare Advantage, ACA, and ESRD programs
Domain
Healthcare / Risk Adjustment
Required skills
HCC Coding, Medical Coding, Clinical Terminology, Anatomy/Physiology, CMS Coding Guidelines, RADV Audits, ICD10 Diagnosis Interpretation, Documentation Analysis, Process Improvement
Preferred skills
Associate degree in medical billing/coding, 5 years HCC coding experience
Technologies
Electronic Medical Record Systems, MS Word, Excel, Outlook, PowerPoint, MS365, Teams
Responsibilities
Perform HCC coding on projects for MA, ACA, and ESRD; Assist with Regulatory Audits by performing first coding review and ranking of charts; Participate in ad-hoc projects and provide recommendations for process improvements; Engage in RPM Coding educational meetings and annual coding Summit.
Seniority
Mid-level, hands-on IC
