Remote HCC Coding Specialist – Risk Adjustment

Highmark Health; Lake Michigan Beach (MI); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking a skilled HCC coder to support Medicare Advantage, ACA, and ESRD risk adjustment initiatives. The role requires interpreting documentation into ICD-10 diagnoses and HCC categories, aligning with CMS guidelines and RPM requirements.

The candidate will collaborate with physicians, Quality, Compliance, and enterprise leadership to ensure accurate coding, participate in audits, and contribute to process improvements. Remote, full-time position with growth opportunities.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing
• Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), and RHIT

Responsibilities

• Performs HCC coding on MA, ACA and ESRD projects, with Retro and Prospective models.
• Supports CMS guidelines and RPM coding accuracy.
• Assists with regulatory audits via initial chart review and ranking.
• Participates in ad-hoc projects and process improvements.
• Engages in RPM coding education and annual coding summit.

Skills

Critical thinking

Attention to detail

Written and oral presentation

Written communications

Communication skills

HCC coding

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

Associate degree in medical billing/coding or health-related field

Job description

Highmark Health is seeking a skilled HCC coder to support Medicare Advantage, ACA, and ESRD risk adjustment initiatives. The role requires interpreting documentation into ICD-10 diagnoses and HCC categories, aligning with CMS guidelines and RPM requirements.

The candidate will collaborate with physicians, Quality, Compliance, and enterprise leadership to ensure accurate coding, participate in audits, and contribute to process improvements. Remote, full-time position with growth opportunities.