Remote HCC Coding Specialist — Medicare Risk Adjustment

Highmark Health; Guin (AL); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health in the United States seeks a skilled HCC Coder to support risk adjustment coding for MA, ACA and ESRD projects. You will interpret physician documentation into ICD-10 diagnoses and HCC categories, working with physicians and teams to ensure accurate capture.

This role emphasizes CMS guidelines, RADV audits, RPM coding initiatives, and opportunities to improve processes. Remote, office-based position with potential travel within 0-25%.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing
• Strong knowledge of CMS guidelines and RADV audits
• Experience with RPM coding education and audits
• Excellent written and verbal communication skills
• MS Word, Excel, Outlook, PowerPoint proficiency

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects across models using various EMR systems.
• Supports regulatory audits with initial chart review and ranking.
• Participates in ad-hoc projects and recommends process improvements.
• Engages in RPM coding educational meetings and annual coding Summit.
• Ensures CMS guidelines compliance and productivity targets.

Skills

HCC Coding

Critical Thinking

Attention to Detail

Written and Oral Presentation Skills

Written Communications

Communication Skills

Education

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

Certified Professional Coder (CPC)

Certified Risk Coder (CRC)

Certified Coding Specialist (CCS)

Registered Health Information Technician (RHIT)

Tools

MS Word

Excel

Outlook

PowerPoint

Job description

Highmark Health in the United States seeks a skilled HCC Coder to support risk adjustment coding for MA, ACA and ESRD projects. You will interpret physician documentation into ICD-10 diagnoses and HCC categories, working with physicians and teams to ensure accurate capture.

This role emphasizes CMS guidelines, RADV audits, RPM coding initiatives, and opportunities to improve processes. Remote, office-based position with potential travel within 0-25%.