Remote HCC Coding Specialist | Risk Adjustment Expert

Highmark Health; Clayton (NC); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health seeks a skilled HCC coder to support risk adjustment coding for Medicare Advantage and ACA programs. You will perform HCC coding across MA, ACA, and ESRD projects, work with physicians and teams, and ensure CMS guidelines and RPM requirements are correctly applied.

The role emphasizes accuracy, documentation improvement, audits, and education; remote office-based work with travel up to 25% aligns with RPM initiatives.

Qualifications

• 3 years HCC coding and/or coding and billing (required).
• 5 years HCC coding and/or coding and billing (preferred).
• Certified Professional Coder (CPC), CRC, CCS, RHIT credentials preferred.

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Participates on ad-hoc projects per the direction of Leadership to address department needs.
• Engages in RPM coding educational meetings and annual coding Summit.
• Other duties as assigned.

Skills

HCC Coding

Attention to Detail

Critical Thinking

Written Communications

Communication Skills

MS Office Suite

Education

Associate degree (preferred)

Tools

MS Office Suite

Job description

Highmark Health seeks a skilled HCC coder to support risk adjustment coding for Medicare Advantage and ACA programs. You will perform HCC coding across MA, ACA, and ESRD projects, work with physicians and teams, and ensure CMS guidelines and RPM requirements are correctly applied.

The role emphasizes accuracy, documentation improvement, audits, and education; remote office-based work with travel up to 25% aligns with RPM initiatives.