Remote HCC Coding Specialist - Risk Adjustment & Audits

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 deliver accurate risk adjustment coding for Medicare Advantage, ACA, and ESRD programs. You will interpret clinical documentation into ICD-10 and HCC categories while adhering to CMS guidelines and Highmark policies.

The role involves collaborating with physicians and teams across Quality, Compliance, and Enterprise leadership to drive quality, compliance, and process improvements in RPM initiatives and RADV audits.

Qualifications

• 3 years HCC coding and/or coding and billing (Required)
• 5 years HCC coding and/or coding and billing (Preferred)

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD; works independently across multiple coding systems to support goals.
• Assists with Regulatory Audits by performing first coding review and ranking of charts; partners with coding teams.
• Participates on ad-hoc projects to identify process improvements and efficiencies.
• 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 Office Suite

MS365 & Teams

Job description

Highmark Health is seeking a skilled HCC coder to deliver accurate risk adjustment coding for Medicare Advantage, ACA, and ESRD programs. You will interpret clinical documentation into ICD-10 and HCC categories while adhering to CMS guidelines and Highmark policies.

The role involves collaborating with physicians and teams across Quality, Compliance, and Enterprise leadership to drive quality, compliance, and process improvements in RPM initiatives and RADV audits.