Hierarchical Condition Category (HCC) Coding Specialist

Perform HCC coding on projects for Medicare Advantage, ACA, and End Stage Renal Disease using CMS guidelines and Highmark policies. Analyze physician documentation to interpret ICD-10 diagnoses and HCC disease categories for Risk Adjustment Data Validation audits. Flex between retro and prospective coding projects across different models while maintaining RPM coding accuracy and productivity requirements. Conduct first-level coding reviews and chart rankings for regulatory audits, then provide recommendations for process improvements and efficiencies to the leadership team. Engage in RPM coding educational meetings and annual summits to support documentation improvement and provider education initiatives.