Remote HCC Coding Specialist for Medicare Risk Adjustment

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

Job summary

Highmark Health is seeking a skilled Risk Adjustment Coder to deliver HCC coding for MA/ACA programs. You will interpret physician documentation into ICD-10 and HCC categories, support RPM coding, and ensure CMS guidelines compliance. Remote, office-based position requiring strong analytical and communication skills.

Responsibilities include audits, chart reviews, and collaboration with providers and leadership to improve documentation and coding accuracy across multiple projects.

Qualifications

• 3 years HCC coding and/or coding and billing experience
• 5 years HCC coding and/or coding and billing preferred
• Certified Professional Coder (CPC) is required
• Certified Risk Coder (CRC) is required
• Certified Coding Specialist (CCS) is required
• Registered Health Information Technician (RHIT) is required

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD. Works independently in various coding applications and EMR systems to support departmental goals.
• Adheres to CMS Guidelines for Coding and Highmark’s policies to guide HCC coding decisions; maintains RPM coding accuracy and productivity.
• Assists with Regulatory Audits by performing first coding review and ranking of charts; builds partnerships within coding teams and internal partners.
• Participates on ad-hoc projects per Leadership direction; provides recommendations for process improvements and efficiencies.
• Engages in RPM Coding educational meetings and annual coding Summit.
• Other duties as assigned.

Skills

HCC coding

CMS guidelines

Regulatory audits

Communication skills

Critical thinking

Attention to detail

Documentation accuracy

Remote collaboration

Education

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

Tools

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Job description

Highmark Health is seeking a skilled Risk Adjustment Coder to deliver HCC coding for MA/ACA programs. You will interpret physician documentation into ICD-10 and HCC categories, support RPM coding, and ensure CMS guidelines compliance. Remote, office-based position requiring strong analytical and communication skills.

Responsibilities include audits, chart reviews, and collaboration with providers and leadership to improve documentation and coding accuracy across multiple projects.