HCC Coding Specialist | Risk Adjustment Expert

Highmark Health; Rhode Island; Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health seeks a skilled HCC Coder to support risk adjustment initiatives across Medicare Advantage, ACA, and ESRD programs. Apply HCC coding, ICD-10, and CMS guidelines, collaborating with physicians and teams to ensure accurate documentation and coding quality.

This role supports RPM coding projects and regulatory audits, participates in education sessions, and helps drive process improvements while adhering to HIPAA and privacy policies.

Qualifications

• 3 years HCC coding and/or coding and billing.
• Associate degree in medical billing/coding preferred.
• CPC, CRC, CCS, RHIT certifications preferred.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects; flexes between models; uses multiple EMR systems.
• Assists with regulatory audits by performing first coding review and chart ranking.
• Works on ad-hoc projects per leadership; suggests process improvements and efficiencies.
• Participates in RPM coding educational meetings and annual coding Summit.
• Other duties as assigned.

Skills

HCC Coding

Attention to Detail

Critical Thinking

Communication Skills

Written and Oral Presentation Skills

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

Associate degree in medical billing/coding

Tools

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Job description

Highmark Health seeks a skilled HCC Coder to support risk adjustment initiatives across Medicare Advantage, ACA, and ESRD programs. Apply HCC coding, ICD-10, and CMS guidelines, collaborating with physicians and teams to ensure accurate documentation and coding quality.

This role supports RPM coding projects and regulatory audits, participates in education sessions, and helps drive process improvements while adhering to HIPAA and privacy policies.