Remote HCC Coding Specialist - Risk Adjustment & Audits

highmarkhealth; Pennsylvania; Hybrid; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking a skilled HCC coder to deliver risk adjustment coding for MA, ACA, and ESRD projects. You will work with physicians and internal teams to interpret medical records into ICD-10 and HCC categories while adhering to CMS guidelines and RPM requirements.

The role emphasizes accuracy, regulatory audits support, and process improvements, with remote, office-based work and up to 25% travel.

Qualifications

• 3 years HCC coding and/or coding and billing experience required.
• 5 years HCC coding and/or coding and billing preferred.
• Associate degree in medical billing/coding or related field preferred.
• CPC, CRC, CCS or RHIT certification preferred.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD, using various MA/ESRD/ACA models.
• Assists with regulatory audits by performing first coding review and ranking charts.
• Engages in RPM coding education meetings and annual coding Summit.

Skills

HCC Coding

CMS Guidelines

Attention to Detail

Communication Skills

MS Word/Excel

Education

Associate degree in medical billing/coding

Tools

CPC

CRC

CCS

RHIT

Job description

Highmark Health is seeking a skilled HCC coder to deliver risk adjustment coding for MA, ACA, and ESRD projects. You will work with physicians and internal teams to interpret medical records into ICD-10 and HCC categories while adhering to CMS guidelines and RPM requirements.

The role emphasizes accuracy, regulatory audits support, and process improvements, with remote, office-based work and up to 25% travel.