Deliver value to the health plan and its members in risk-adjusted government programs such as Medicare Advantage and ACA by performing HCC coding, reviewing physician documentation, and translating it into accurate ICD-10 diagnoses and HCC disease categories.
This role supports remote patient monitoring (RPM) risk adjustment initiatives, regulatory audits, provider education, documentation improvement, and process improvement efforts. The position works closely with physicians, quality, compliance, enterprise partners, and leadership to ensure accurate risk adjustment coding and compliance with CMS requirements.
Requirements & Qualifications
- 3 years of HCC coding and/or coding and billing experience required
- Preferred: 5 years of HCC coding and/or coding and billing experience
- Certification required: CPC, CRC, CCS, or RHIT
- Preferred education: associate degree in medical billing/coding, health insurance, healthcare, or related field
- Knowledge of HCC coding, medical coding, clinical terminology, anatomy/physiology, CMS coding guidelines, and RADV audits
- Proficiency with MS Word, Excel, Outlook, PowerPoint, and Microsoft 365/Teams
- Strong critical thinking, attention to detail, written and verbal communication, and presentation skills
Location
Pennsylvania, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago