**Company :**
Highmark Inc.
**Job Description :**

**JOB SUMMARY**

This job will deliver value to the Health Plan and its beneficiaries enrolled in risk-adjusted government 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 ...