Remote HCC Coding Specialist - Risk Adjustment

Highmark Health; Honolulu (HI); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. is seeking a seasoned HCC coder to support risk adjustment projects for Medicare Advantage and ACA programs.

You will work across MA, ACA, and ESRD models, using CMS guidelines and RADV practices, integrating documentation into ICD-10 diagnoses and HCC categories. You will collaborate with physicians, QA teams, and leadership to ensure accurate coding, participate in RPM initiatives, and contribute to process improvements and audits.

Qualifications

• HCC coding experience required (3 years).
• Preferred 5 years HCC coding and/or coding and billing.
• CPC/CRC/CCS/RHIT type certifications encouraged.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects.
• Adheres to CMS guidelines and Highmark policies.
• Supports RPM coding educational meetings and audits.
• Assists with regulatory audits by initial chart review.
• Collaborates with clinicians and internal partners on process improvements.

Skills

Critical Thinking

Attention to Detail

Written and Oral Presentation Skills

Written Communications

Communication Skills

HCC Coding

MS Word, Excel, Outlook, PowerPoint

Microsoft Office Suite Proficient/ - 3

Education

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

Job description

Highmark Inc. is seeking a seasoned HCC coder to support risk adjustment projects for Medicare Advantage and ACA programs.

You will work across MA, ACA, and ESRD models, using CMS guidelines and RADV practices, integrating documentation into ICD-10 diagnoses and HCC categories. You will collaborate with physicians, QA teams, and leadership to ensure accurate coding, participate in RPM initiatives, and contribute to process improvements and audits.