Remote HCC Coding Specialist – Risk Adjustment Expert

Highmark Health; Arkansas City (KS); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. seeks a skilled HCC coder to support Medicare Advantage, ACA, and ESRD projects. You will analyze physician documentation, translate it into ICD-10 diagnoses and HCCs, and ensure RPM coding accuracy while supporting audits and process improvements.

Responsibilities include coding across MA/ACA projects, staying compliant with CMS rules, and collaborating with clinicians, quality, and compliance teams to drive high-quality risk adjustment outcomes.

Qualifications

• 3 years HCC coding and/or coding and billing experience.
• Certified Professional Coder (CPC) required; CRC, CCS, RHIT preferred.
• Associate degree in medical billing/coding or related field preferred.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects across models; uses multiple systems.
• Adheres to CMS guidelines and Highmark policies to guide coding decisions.
• Maintains RPM coding accuracy and productivity requirements.
• Assists with regulatory audits by performing initial chart reviews and ranking.

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 Inc. seeks a skilled HCC coder to support Medicare Advantage, ACA, and ESRD projects. You will analyze physician documentation, translate it into ICD-10 diagnoses and HCCs, and ensure RPM coding accuracy while supporting audits and process improvements.

Responsibilities include coding across MA/ACA projects, staying compliant with CMS rules, and collaborating with clinicians, quality, and compliance teams to drive high-quality risk adjustment outcomes.