Remote HCC Coding Specialist | Risk Adjustment & Audits

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

Job summary

Highmark Health seeks an experienced HCC coder to support risk adjustment initiatives for MA, ACA, and ESRD programs, translating clinical documentation into ICD-10 diagnoses and HCC categories per CMS guidelines.

You will collaborate with physicians, quality, compliance, and enterprise leadership to ensure accurate coding, participate in RPM projects, audits, and ongoing education to improve risk capture.

Qualifications

• Minimum 3 years HCC coding and/or coding and billing experience.
• Preferred 5 years HCC coding and/or coding and billing experience.
• Experience with CMS guidelines and RADV audits is desirable.

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD across various models.
• Works independently in multiple coding applications and EMR systems.
• Assists with regulatory audits by performing first coding review and chart ranking.
• Participates in ad-hoc projects and process improvement initiatives.
• Engages in RPM coding educational meetings and annual coding Summit.

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 Health seeks an experienced HCC coder to support risk adjustment initiatives for MA, ACA, and ESRD programs, translating clinical documentation into ICD-10 diagnoses and HCC categories per CMS guidelines.

You will collaborate with physicians, quality, compliance, and enterprise leadership to ensure accurate coding, participate in RPM projects, audits, and ongoing education to improve risk capture.