Remote HCC Coding Specialist for Risk Adjustment

Highmark Health; Philadelphia (Philadelphia County); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. is seeking a skilled HCC coder to support Medicare Advantage, ACA, and ESRD coding projects. You will work across multiple models, adhering to CMS guidelines and RPM requirements to ensure accurate risk adjustment data.

The role involves collaboration with physicians, Quality, Compliance, and Enterprise leadership to drive quality and compliant coding, with opportunities for process improvements and training on coding best practices.

Qualifications

• 3 years HCC coding and/or coding and billing experience.
• 5 years HCC coding and/or coding and billing experience preferred.
• Certifications such as CPC, CRC, CCS, or RHIT are valued.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects.
• Adheres to CMS Guidelines for Coding and RPM coding standards.
• Assists with Regulatory Audits by performing initial chart review.
• Participates in ad-hoc projects and recommends process improvements.

Skills

Critical Thinking

Attention to Detail

Oral Presentation

Written Communications

Communication Skills

HCC Coding

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

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

Job description

Highmark Inc. is seeking a skilled HCC coder to support Medicare Advantage, ACA, and ESRD coding projects. You will work across multiple models, adhering to CMS guidelines and RPM requirements to ensure accurate risk adjustment data.

The role involves collaboration with physicians, Quality, Compliance, and Enterprise leadership to drive quality and compliant coding, with opportunities for process improvements and training on coding best practices.