Remote HCC Coding Specialist for Risk Adjustment

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

Job summary

Highmark Health is seeking a Remote HCC Coder to support Medicare Advantage, ACA, and ESRD projects. You will interpret clinical documentation into ICD-10 and HCC categories, collaborate with physicians and teams, and ensure compliance with CMS guidelines and company policies.

Role emphasizes accuracy, audits, and process improvements, with remote office-based work and occasional travel up to 25%. Requires CPC/CRC/CCS/RHIT credentials and 3 years of HCC experience.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing
• Preferred Associate degree in medical billing/coding, health insurance, healthcare or related field

Responsibilities

• Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals. Adheres to CMS Guidelines for Coding and Highmark’s Policy and Procedures to guide HCC coding decision making. Maintains RPM coding accuracy and productivity requirements.
• Assists with Regulatory Audits by performing first coding review and ranking of charts. Build partnerships and work within coding teams and internal partners critical to HCC coding.
• Participates on ad-hoc projects per the direction of Leadership to address the needs of the department. Provides recommendations for process improvements and efficiencies.
• Engages in RPM Coding educational meetings and annual coding Summit.
• Other duties as assigned.

Skills

HCC Coding

Critical Thinking

Attention to Detail

Written and Oral Presentation Skills

Written Communications

Communication Skills

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 Health is seeking a Remote HCC Coder to support Medicare Advantage, ACA, and ESRD projects. You will interpret clinical documentation into ICD-10 and HCC categories, collaborate with physicians and teams, and ensure compliance with CMS guidelines and company policies.

Role emphasizes accuracy, audits, and process improvements, with remote office-based work and occasional travel up to 25%. Requires CPC/CRC/CCS/RHIT credentials and 3 years of HCC experience.