Remote HCC Coding Specialist for Risk Adjustment

Highmark Health; Lorida (FL); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking a skilled Risk Adjustment Coder to deliver accurate HCC coding for MA, ACA, and ESRD projects. The role requires navigating multiple coding systems, CMS guidelines, and RPM initiatives while maintaining quality and compliance across remote work environments.

You will collaborate with physicians, Quality, Compliance, and leadership to ensure proper documentation and effective risk adjustment capture, including training and process improvement efforts.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing

Responsibilities

• Performs HCC coding on projects for MA, ACA, and 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

Critical Thinking

Attention to Detail

Presentation Skills

Written Communications

Communication Skills

HCC Coding

MS Office

MS365 & Teams

Education

Associate degree in medical billing/coding, health insurance, healthcare or related field

Job description

Highmark Health is seeking a skilled Risk Adjustment Coder to deliver accurate HCC coding for MA, ACA, and ESRD projects. The role requires navigating multiple coding systems, CMS guidelines, and RPM initiatives while maintaining quality and compliance across remote work environments.

You will collaborate with physicians, Quality, Compliance, and leadership to ensure proper documentation and effective risk adjustment capture, including training and process improvement efforts.