Remote HCC Coding & Risk Adjustment Specialist

Highmark Health; Butlerville (IN); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health seeks a skilled Risk Adjustment Coder to support Medicare Advantage, ACA, and ESRD projects. You will translate physician documentation into ICD-10 diagnoses and HCC categories, ensuring CMS guidelines are followed and RPM coding is accurate.

This remote role requires 3 years of HCC coding experience, CPC/CRC/CCS/RHIT certifications, and strong attention to detail. You will collaborate with clinicians, QA teams, and auditors to maintain risk capture quality and efficiency.

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Qualifications

• 3 years HCC coding and/or coding and billing.
• If applicable, strong knowledge of CMS guidelines and RAC processes.
• CPC, CRC, CCS, RHIT certifications preferred.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects across models.
• Assists with regulatory audits by initial chart review and ranking.
• Supports RPM coding education and participates in coding summits.
• Contributes to process improvements and cross-team collaboration.
• Maintains coding accuracy and productivity targets.

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/ - 0

Education

Associate degree in medical billing/coding, health insurance, healthcare or related field preferred

Tools

MS Word

Excel

Outlook

PowerPoint

MS 365 & Teams

Job description

Highmark Health seeks a skilled Risk Adjustment Coder to support Medicare Advantage, ACA, and ESRD projects. You will translate physician documentation into ICD-10 diagnoses and HCC categories, ensuring CMS guidelines are followed and RPM coding is accurate.

This remote role requires 3 years of HCC coding experience, CPC/CRC/CCS/RHIT certifications, and strong attention to detail. You will collaborate with clinicians, QA teams, and auditors to maintain risk capture quality and efficiency.

'.$