Remote HCC Coding Specialist for Medicare Risk Adjustment

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

Job summary

Highmark Health in the United States seeks a Certified HCC Coder to support risk adjustment initiatives for MA/ACA programs. You will translate physician documentation into ICD-10 and HCC categories, ensuring CMS guidelines and RPM requirements are met.

Collaborating with physicians, Quality, Compliance and leadership, you will drive accuracy, educate providers, analyze reports, and contribute to process improvements across remote settings.

Qualifications

• 3 years HCC coding and/or coding and billing required.
• 5 years HCC coding and/or coding and billing preferred.
• Associate degree in medical billing/coding preferred.
• Certifications CPC, CRC, CCS, RHIT preferred.

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD. Works independently in various coding applications and EMR systems to support departmental goals.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Participates on ad-hoc projects per Leadership direction to address department needs and recommend process improvements.
• Engages in RPM Coding educational meetings and annual coding Summit.
• Other duties as assigned.

Skills

HCC Coding

Critical Thinking

Attention to Detail

Communication Skills

Written Communications

Written and Oral Presentation Skills

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

Associate degree in medical billing/coding preferred

Tools

EMR systems

Job description

Highmark Health in the United States seeks a Certified HCC Coder to support risk adjustment initiatives for MA/ACA programs. You will translate physician documentation into ICD-10 and HCC categories, ensuring CMS guidelines and RPM requirements are met.

Collaborating with physicians, Quality, Compliance and leadership, you will drive accuracy, educate providers, analyze reports, and contribute to process improvements across remote settings.