Remote HCC Coding Specialist for Risk Adjustment

Highmark Health; Clifton (TX); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking a detail-oriented professional to perform HCC coding for MA, ACA, and ESRD, ensuring alignment with CMS guidelines and Highmark policies. You will support remote RPM projects by translating physician documentation into ICD-10 diagnoses and HCC categories.

The role requires experience in coding across retrospective and prospective models, collaboration with physicians and cross-functional teams, and ongoing participation in coding education and audits.

Qualifications

• 3 years HCC coding and/or coding and billing

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Participates on ad-hoc projects per the direction of Leadership to address the needs of the department.
• Engages in RPM Coding educational meetings and annual coding Summit.

Skills

HCC Coding

CMS Guidelines

RADV Audits

Medical Coding

Clinical Terminology

ICD-10

CP C

CRC

CCS

RHIT

Education

Associate degree in medical billing/coding

Tools

EMR systems

Coding software

MS Word

MS Excel

Job description

Highmark Health is seeking a detail-oriented professional to perform HCC coding for MA, ACA, and ESRD, ensuring alignment with CMS guidelines and Highmark policies. You will support remote RPM projects by translating physician documentation into ICD-10 diagnoses and HCC categories.

The role requires experience in coding across retrospective and prospective models, collaboration with physicians and cross-functional teams, and ongoing participation in coding education and audits.