Remote HCC Coding Specialist – Risk Adjustment

Highmark; United States; Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. seeks a skilled risk adjustment coder to support MA/ACA/ESRD projects, delivering accurate ICD10 diagnoses and HCC category assignments.

You will collaborate with physicians, Quality, Compliance, and enterprise partners to ensure high-quality documentation and coding accuracy. Responsibilities include supporting RPM projects, audits, process improvements, and ongoing education through coding summits and meetings.

Qualifications

• 3 years HCC coding and/or coding and billing (required).
• 5 years HCC coding and/or coding and billing (preferred).
• Certifications: CPC, CRC, CCS, RHIT (required or preferred).
• Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD. Flexes between models; supports RPM coding tasks.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Participates on ad-hoc projects to address department needs and improve processes.
• Engages in RPM Coding educational meetings and annual coding Summit.
• Other duties as assigned.

Skills

Critical Thinking

Attention to Detail

Written and Oral Presentation Skills

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

Tools

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Job description

Highmark Inc. seeks a skilled risk adjustment coder to support MA/ACA/ESRD projects, delivering accurate ICD10 diagnoses and HCC category assignments.

You will collaborate with physicians, Quality, Compliance, and enterprise partners to ensure high-quality documentation and coding accuracy. Responsibilities include supporting RPM projects, audits, process improvements, and ongoing education through coding summits and meetings.