Remote HCC Coding Specialist for Medicare Risk Adjustment

Highmark Health; Nashville (TN); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. is seeking experienced HCC coders to support risk adjustment across MA, ACA, and ESRD programs. You will work with physicians, quality teams, and compliance to ensure accurate ICD-10 and HCC categorization.

Responsibilities include coding across multiple models, participating in audits, and contributing to process improvements. Remote office-based role with travel 0–25% possible.

Qualifications

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

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD.
• Flues between coding projects with different models and teams.
• Adheres to CMS guidelines and Highmark policies.
• Supports regulatory audits with initial chart review and ranking.
• Engages in RPM coding educational meetings and annual coding Summit.
• Suggests process improvements and efficiencies.
• Other duties as assigned.

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

Tools

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Job description

Highmark Inc. is seeking experienced HCC coders to support risk adjustment across MA, ACA, and ESRD programs. You will work with physicians, quality teams, and compliance to ensure accurate ICD-10 and HCC categorization.

Responsibilities include coding across multiple models, participating in audits, and contributing to process improvements. Remote office-based role with travel 0–25% possible.