Provide heritage advice and approvals for diverse projects, deliver across various sectors, investigate heritage matters, and maintain client relationships. Support team skill development through mentorship.

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 such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements. ESSENTIAL RESPONSIBILITIES - Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals. Adheres to CMS Guidelines for Coding and Highmark’s Policy and Procedures to guide HCC coding decision making. Maintains RPM coding accuracy and productivity requirements. - Assists with Regulatory Audits by performing first coding review and ranking of charts. Build partnerships and work within coding teams and internal partners critical to HCC coding. - Participates on ad-hoc projects per the direction of Leadership to address the needs of the department. Provides recommendations for process improvements and efficiencies. - Engages in RPM Coding educational meetings and annual coding Summit. - Other duties as assigned. EDUCATION Required - None Substitutions - None Preferred - Associate degree in medical billing/coding, health insurance, healthcare or related field preferred. EXPERIENCE Required - 3 years HCC coding and/or coding and billing Preferred - 5 years HCC coding and/or coding and billing LICENSES or CERTIFICATIONS Required (any of the following) - Certified Professional Coder (CPC) - Certified Risk Coder (CRC) - Certified Coding Specialist (CCS) - Registered Health Information Technician (RHIT) Preferred - None SKILLS - Critical Thinking - Attention to Detail - Written and Oral Presentation Skills - Written Communications - Communication Skills - HCC Coding - MS Word, Excel, Outlook, PowerPoint - Microsoft Office Suite Proficient/ - MS365 & Teams Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Remote Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $27.02 Pay Range Maximum: $41.85 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

• Responsible for reviewing adjustments submitted by billing specialists for accuracy • Research rate discrepancies or possible eligibility issues • Interpret contracts to understand invoicing impact • Perform accounting and financial work involving billing preparation, research, analysis, recording, reconciliation and reporting • Support audit requests relative to revenue including audit sampling for various types of transactions • Assist Assistant Controller with month-over-month analysis, researching and resolving invoicing discrepancies • Assist with escalations when first and second attempts are not successful • Analyze billing procedures and identify opportunities for improvement • Coordinate with Sales, Contracting, Fleet Ops, and Logistics staff members as needed • Prepare reports for ledgers, reconcile statements and ensure data integrity • Perform account research, analyze variances and prepare appropriate reports • Support audit and revenue sampling for all revenue transactions

ClinicMind’s core values—Excellence · Learning · Teamwork guide everything we build. With 150 in‑house analysts, half a dozen BPO partners, and a proprietary billing platform, we now need a manager to deliver best‑in‑class collections, continue to improve performance, automate, and meet the RCM needs of a rapidly growing client base. Overview We are seeking a Level 3 Billing Support / Billing Review Subject Matter Expert (SME) to join our team. This role serves as the final point of escalation for complex billing concerns and systemic claim issues. The SME team ensures accuracy in claim processing, resolves systemic billing setup problems, and provides expert support to billing staff, providers, and retention teams. Experience with ClinicMind/Vericle software is required. Key Responsibilities - Handle high-level billing escalations and serve as a subject matter expert for complex claim issues. - Review claims to identify errors caused by system setup or process gaps. - Collaborate with SYSADMIN to correct systemic configuration issues and validate updates. - Provide data and guidance on affected claims to billing teams and providers for manual resolution. - Support provider and retention teams by explaining billing outcomes and corrective actions clearly. - Document recurring issues and recommend workflow or system improvements. - Mentor Level 1 and Level 2 billing support staff, sharing expertise and best practices. - Lead or participate in small projects related to billing reviews, system changes, and process enhancements. Qualifications - Bachelor’s degree in Business, Healthcare Administration, Finance, or equivalent work experience. - 4–6 years of experience in medical billing, claim review, or revenue cycle management. - Mandatory: Hands-on experience with ClinicMind/Vericle software. - Strong knowledge of billing workflows, claim adjudication, and payer requirements. - Excellent communication skills to interact with providers, billing teams, and technical staff. - Strong analytical and problem-solving abilities with attention to detail. - Basic project management experience (managing timelines, priorities, and stakeholder coordination). Preferred Skills - Prior experience collaborating with system administrators on billing setups. - Knowledge of compliance standards and payer regulations. - Ability to train or mentor junior staff. Must Have: - High comfort level working on Eastern Time Zone/US Shift - Good internet access at home - Mobile Hotspot - Laptop/Desktop with at least 16 GB