Remote HCC Coding Specialist for Medicare & ACA

Highmark Health; West Virginia; Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking a skilled Risk Adjustment Coder to support HCC coding for Medicare Advantage, ACA, and ESRD programs. You will translate physician documentation into ICD-10 and HCC categories, adhering to CMS guidelines and Highmark policies.

This remote office-based role collaborates with physicians, Quality, Compliance, and enterprise leadership to ensure accurate risk capture. Responsibilities include performing coding across multiple models, supporting RPM coding projects,

Qualifications

• 3 years HCC coding and/or coding and billing.
• CPC, CRC, CCS, and RHIT certifications are required.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects across multiple models.
• Works independently in various coding applications and EMR systems.
• Assists regulatory audits with initial chart review and ranking.
• Partners with coding teams and internal stakeholders to support HCC coding.
• Participates in ad-hoc projects and process-improvement initiatives.
• Engages in RPM coding educational meetings and the annual coding Summit.

Skills

Critical Thinking

Attention to Detail

Written and Oral Presentation Skills

Written Communications

Communication Skills

HCC Coding

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

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

Job description

Highmark Health is seeking a skilled Risk Adjustment Coder to support HCC coding for Medicare Advantage, ACA, and ESRD programs. You will translate physician documentation into ICD-10 and HCC categories, adhering to CMS guidelines and Highmark policies.

This remote office-based role collaborates with physicians, Quality, Compliance, and enterprise leadership to ensure accurate risk capture. Responsibilities include performing coding across multiple models, supporting RPM coding projects,