Remote HCC Coding Specialist (Risk Adjustment)

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

Job summary

Highmark Health is seeking a skilled HCC coder to deliver accurate risk adjustment coding for MA, ACA, and ESRD projects. You will work across Retro and Prospective models, ensuring documentation aligns with CMS guidelines while maintaining RPM coding accuracy.

You will collaborate with physicians and internal teams, participate in audits, and contribute to process improvements. Remote office-based with travel 0–25% may apply.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing preferred
• Certifications: CPC, CRC, CCS, RHIT preferred or required

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects across multiple models.
• Adheres to CMS guidelines and Highmark policies for coding decisions.
• Supports RPM coding projects and CMS requirements.
• Participates in regulatory audits with initial chart review.
• Identifies process improvements and educational opportunities.

Skills

HCC Coding

Critical Thinking

Attention to Detail

Communication Skills

Written Communications

Written and Oral Presentation Skills

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

Associate degree in medical billing/coding or related field

Job description

Highmark Health is seeking a skilled HCC coder to deliver accurate risk adjustment coding for MA, ACA, and ESRD projects. You will work across Retro and Prospective models, ensuring documentation aligns with CMS guidelines while maintaining RPM coding accuracy.

You will collaborate with physicians and internal teams, participate in audits, and contribute to process improvements. Remote office-based with travel 0–25% may apply.