Remote HCC Coding Specialist – Medicare Risk Adjustment

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

Job summary

Highmark Health in the United States is seeking a skilled HCC Coder to support Risk Adjustment programs including Medicare Advantage and ACA. You will interpret clinical documentation into ICD-10 diagnoses and HCC categories, ensuring CMS guidelines are followed and RPM data remains compliant.

The role collaborates with physicians, Quality, Compliance, and Enterprise leaders to deliver accurate coding, support audits, and drive process improvements while working remotely within the country.

Qualifications

• 3 years HCC coding and/or coding and billing experience.
• Experience with CMS guidelines and RADV/audits is a plus.
• Proven ability to interpret clinical documentation into ICD10/HCC.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects, using multiple models.
• Supports regulatory audits with initial chart review and ranking.
• Collaborates with leadership and internal partners to improve processes.
• Engages in RPM coding education meetings and coding summits.
• Maintains RPM coding accuracy and productivity requirements.

Skills

HCC Coding

Attention to Detail

Critical Thinking

Written and Oral Communication

Regulatory Knowledge

Communication Skills

Medical Terminology

Education

Associate degree in medical billing/coding

Tools

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Job description

Highmark Health in the United States is seeking a skilled HCC Coder to support Risk Adjustment programs including Medicare Advantage and ACA. You will interpret clinical documentation into ICD-10 diagnoses and HCC categories, ensuring CMS guidelines are followed and RPM data remains compliant.

The role collaborates with physicians, Quality, Compliance, and Enterprise leaders to deliver accurate coding, support audits, and drive process improvements while working remotely within the country.