Remote HCC Coding Specialist for Risk Adjustment

Highmark Health; Charleston (WV); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. seeks an experienced HCC coder to support risk adjustment for MA and ACA programs. You will perform HCC coding and translate clinical documentation into ICD-10 diagnoses, collaborating with physicians, quality, compliance, and leadership to ensure accurate risk capture and RPM project support.

The role requires CMS guideline adherence, audit readiness, and opportunity to improve processes. 3 years of HCC coding experience is required; 5 years preferred.

Qualifications

• 3 years HCC coding and/or coding and billing
• Preferred 5 years HCC coding and/or coding and billing
• Certifications (CPC/CRC/CCS/RHIT) accepted
• Experience with CMS guidelines and RPM coding
• Ability to translate clinical documentation into ICD-10 diagnoses

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects
• Flexes between Retro and Prospective models and multiple applications
• Adheres to CMS guidelines and Highmark policies
• Supports RPM coding accuracy and productivity requirements
• Assists with regulatory audits and charts ranking
• Collaborates with internal partners and leadership to improve processes

Skills

Critical Thinking

Attention to Detail

Written and Oral Presentation Skills

Written Communications

Communication Skills

HCC Coding

Education

Associate degree in medical billing/coding

Tools

MS Word

Excel

Outlook

PowerPoint

Job description

Highmark Inc. seeks an experienced HCC coder to support risk adjustment for MA and ACA programs. You will perform HCC coding and translate clinical documentation into ICD-10 diagnoses, collaborating with physicians, quality, compliance, and leadership to ensure accurate risk capture and RPM project support.

The role requires CMS guideline adherence, audit readiness, and opportunity to improve processes. 3 years of HCC coding experience is required; 5 years preferred.