Remote HCC Coding Specialist for Medicare Risk Adjustment

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

Job summary

Highmark Health is seeking a remote-based Senior HCC Coder to support Medicare Advantage, ACA, and ESRD coding initiatives. You will translate physician documentation into ICD-10 diagnoses and HCC categories, ensuring CMS guidelines are followed and RPM projects remain compliant.

The role requires professional certifications and 3+ years of HCC coding experience, with up to 25% travel to sites as needed. Collaboration with physicians and compliance teams is essential.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing (preferred)
• CPC/CRC/CCS/RHIT certifications preferred

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects across models; works independently in various coding applications and EHR systems.
• Adheres to CMS Guidelines for Coding and Highmark’s Policies and Procedures to guide HCC coding decisions.
• Supports Regulatory Audits by performing first coding review and ranking of charts.
• Engages in RPM coding educational meetings and annual coding Summit.

Skills

Critical Thinking

Attention to Detail

Written & Oral Presentation

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

Tools

MS Office Suite

Job description

Highmark Health is seeking a remote-based Senior HCC Coder to support Medicare Advantage, ACA, and ESRD coding initiatives. You will translate physician documentation into ICD-10 diagnoses and HCC categories, ensuring CMS guidelines are followed and RPM projects remain compliant.

The role requires professional certifications and 3+ years of HCC coding experience, with up to 25% travel to sites as needed. Collaboration with physicians and compliance teams is essential.