Highmark.
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Pittsburgh, PA
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Irreversible. -
Full-time.
Business: Highmark Inc.
Job Description:
JOB SUMMARY
The task specifies, strategies and provides complicated jobs that need cross-functional partnership and management of inter-dependencies in between a group of tasks and/or associated activities within the restrictions of scope, quality, time and budget plan. Consists of the coordination and management of a group of internal staff members who serve on the program( s) to specify, carry out and provide the program goals. The task keeps track of federal government standards to recognize and notify crucial stakeholders and choice makers of requireds and requirements to fulfill compliance per CMS standards and ICD-10 Coding Guidelines. Handles the designated program, guarantees details is evidence-based and utilizes analytics approaches and principals to resolve business and scientific requirements of the program. The incumbent owns the advancement and upkeep of last program documents in addition to handling a cadence and the products utilized for updates to management. Shows coding and scientific understanding and experience in analyzing and summing up findings and reports. This task likewise provides extremely complicated HCC coding in assistance of MA and ACA threat change designs and in-depth and intricate medical record evaluations for assistance of regulative audits. The incumbent will be accountable to make updates and develop products to show brand-new and/or current service jobs in addition to modifications to procedures or systems and keep an eye on results to guarantee knowing and adherence to job particular standards. The incumbent might team up with innovation partners relating to the advancement and upkeep of systems, programs, software application and other tools related to HCC Coding. Handles the RPM Coding supplier relationships as they associate with their job( s) results.
ESSENTIAL RESPONSIBILITIES
- Plans and handles complicated tasks that need cross-functional groups associated with RPM Coding and Quality programs. Offers job management within scope, quality, time and budget plan. Consists of the coordination of internal groups and potentially a supplier, to specify, carry out and provide on the job. Uses task management approaches and tools in helping with program goals. Assesses threats to tasks and establishes technique for danger mitigation to report to management. Prepares and interacts task status updates, timeline and results to management and supplies any timeline adjustments as needed.
- Performs HCC coding on tasks for MA, ACA, and ESRD. Capability to bend in between coding jobs, consisting of Audits, Retro and Prospective, with various MA, ESRD, and ACA HCC Models. Capability to work separately in different coding applications and electronic medical record systems to support department objectives. Sticks To CMS Guidelines for Coding and Highmark’s Policy and Procedures to assist HCC coding choice making. Function as SME on HCC Coding standards and procedures. Keeps RPM coding precision and performance requirements.
- Collaborates with management and management to put together task group and work groups to produce deliverables needed to attain the goals of a specified RPM job. Functions with management to stay versatile with job group to attain all RPM due dates.
- Other responsibilities as appointed or asked for.
EDUCATION
Required
- Bachelor’s Degree in Healthcare, Business or a Clinical associated field
Substitutions
- 6 years of associated and progressive experience in lieu of Bachelor’s degree
Preferred
- None
EXPERIENCE
Required
- 6 years in HCC Coding and/or a Healthcare setting
Preferred
- 10 years in HCC Coding and/or a Healthcare setting
- 3 years of RADV Auditing
- 3 years of Coding QA
- 3 years with HEDIS/Stars
- 3 years as a LPN or REGISTERED NURSE
- 3 years in Project Management
- 1 year in a management or management function
LICENSES or CERTIFICATIONS
Required
- None
Preferred (any of the following)
- Certified Professional Coder (CPC)
- Certified Risk Coding Certifications (CRC)
- Certified Coding Specialist Certification (CCS)
- Registered Health Information Technician Certification (RHIT)
- AAPC/AHIMA Documentation Improvement (CDEO or CDIP)
Certified Documentation Expert Outpatient (CDEO) or Certified Documentation Improvement Practitioner (CDIP)
SKILLS
- Critical Thinking
- Attention to Detail
- Ability to Work Independently
- Written and Oral Presentation Skills
- Written Communications
- Oral Communication Skills
- CMS Risk Adjustment & HCC Coding
- Microsoft Office Suite Proficient – MS365 and Teams
Language (Other than English):
None
Travel Requirement:
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches/ trains others routinely
Occasionally
Travel routinely from the workplace to different work websites or from site-to-site
Rarely
Works mostly out-of-the workplace offering products/services (sales staff members)
Never
Physical work website needed
Yes
Lifting: approximately 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The task description has actually been created to show the basic nature and necessary tasks and duties of work carried out by staff members within this task title. It might not include a thorough stock of all tasks, duties, and certifications needed of workers to do this task.
Compliance Requirement: This task complies with the ethical and legal requirements and behavioral expectations as stated in the code of company conduct and business policies.
As an element of task duties, workers might have access to covered info, cardholder information, or other personal client details that should be safeguarded at all times. In connection with this, all workers need to adhere to both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as explained in the Notice of Privacy Practices and Privacy Policies and Procedures in addition to all information security standards developed within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every staff member’s obligation to abide by the business’s Code of Business Conduct. This consists of however is not restricted to adherence to appropriate federal and state laws, guidelines, and guidelines in addition to business policies and training requirements.
Highmark Health and its affiliates forbid discrimination versus certified people based upon their status as safeguarded veterans or people with impairments, and forbid discrimination versus all people based upon their race, color, religious beliefs, sex, nationwide origin, sexual orientation/gender identity or any other classification safeguarded by relevant federal, state or regional law. Highmark Health and its affiliates take affirmative action to use and advance in work people without regard to race, color, religious beliefs, sex, nationwide origin, sexual orientation/gender identity, safeguarded seasoned status or impairment.
Highmark Health and its affiliates forbid discrimination versus certified people based upon their status as secured veterans or people with specials needs, and forbid discrimination versus all people based upon their race, color, age, faith, sex, nationwide origin, sexual orientation/gender identity or any other classification safeguarded by relevant federal, state or regional law. Highmark Health and its affiliates take affirmative action to use and advance in work people without regard to race, color, age, faith, sex, nationwide origin, sexual orientation/gender identity, secured seasoned status or special needs.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ()
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