Lead Hierarchical Condition Category (HCC) Coding Specialist - (Remote)

Job description

Company: Endorsed Job Description: JOB SUMMARY This job will deliver value to the Enhanced Community Care Management (ECCM) clinical risk assessment programs (MA and ACA) through Hierarchical Condition Category (HCC) coding, medical coding, clinical terminology and anatomy/physiology, CMS coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits. Conducts quality assurance (QA) review of internal coding team members, provides coding education to team, evaluates HCC coding questions and independently renders guidance on appropriate coding determinations. The incumbent supports RADV audits, specializing in performing second level review of HCC validation and research of outstanding HCCs; prepares documentation and coversheets for upload to regulatory body and/or independent auditor, and analyzes results. May also be responsible for high-priority and key strategic provider entities and/or anchor partners to analyze and evaluate coding trends; proactively identify issues and present solutions to internal leadership and external entities; leads activities with provider entities. Works closely with colleagues, leadership, enterprise matrix partners (such as quality...