Remote HCC Coding Specialist – Risk Adjustment & Audits

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

Job summary

Highmark Health is seeking a skilled HCC coder to support Medicare Advantage and ACA risk adjustment projects from a remote office-based setting. You will translate clinical documentation into ICD-10 diagnoses and HCC categories, collaborating with physicians and cross-functional teams to ensure accurate risk adjustment coding.

Responsibilities include coding across MA, ACA, and ESRD models, supporting audits, and driving process improvements.

Qualifications

• 3 years HCC coding and/or coding and billing experience required.
• 5 years HCC coding and/or coding and billing experience preferred.
• CPC, CRC, CCS, RHIT certifications are required or preferred as listed in the job posting.

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD, in various coding models and systems.
• Adheres to CMS Guidelines and Highmark policies for coding decisions.
• Assists with Regulatory Audits by performing first coding review and chart ranking.
• Participates on ad-hoc projects and RPM coding education sessions.

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

Job description

Highmark Health is seeking a skilled HCC coder to support Medicare Advantage and ACA risk adjustment projects from a remote office-based setting. You will translate clinical documentation into ICD-10 diagnoses and HCC categories, collaborating with physicians and cross-functional teams to ensure accurate risk adjustment coding.

Responsibilities include coding across MA, ACA, and ESRD models, supporting audits, and driving process improvements.