Remote HCC Coding Specialist for Medicare & ACA

Highmark Health; Clayton (MO); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health in the United States is seeking a Risk Adjustment Coding Specialist to deliver accurate HCC coding for MA, ACA and ESRD projects. The role requires proficiency in ICD-10, HCC models, and CMS guidelines, with remote office-based work and quarterly audits.

You will collaborate with physicians, Quality and Compliance teams to improve documentation, support RPM initiatives, and participate in ongoing coding education.

Qualifications

• 3 years HCC coding and/or coding and billing.
• Certification in CPC, CRC, CCS, or RHIT is required.
• Knowledge of CMS guidelines and RPM coding processes.
• Experience with regulatory audits and documentation improvement.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects.
• Adheres to CMS Guidelines and Highmark policies guiding HCC coding decisions.
• Supports RPM coding accuracy and productivity requirements.
• Assists with regulatory audits by performing first coding review and chart ranking.
• Participates in ad-hoc projects and coding education meetings.

Skills

Critical Thinking

Attention to Detail

Written Presentation

Written Communications

Communication Skills

HCC Coding

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

Associate degree in medical billing/coding

Job description

Highmark Health in the United States is seeking a Risk Adjustment Coding Specialist to deliver accurate HCC coding for MA, ACA and ESRD projects. The role requires proficiency in ICD-10, HCC models, and CMS guidelines, with remote office-based work and quarterly audits.

You will collaborate with physicians, Quality and Compliance teams to improve documentation, support RPM initiatives, and participate in ongoing coding education.