Remote HCC Coding Specialist | Risk Adjustment Expert

Highmark Health; Elm (PA); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health in Pennsylvania seeks a skilled HCC coder to support risk adjustment projects for Medicare Advantage and ACA populations. You will translate physician documentation into ICD-10 diagnoses and HCC categories in line with CMS guidelines and RADV audit requirements.

You will collaborate with physicians, Quality, Compliance, and enterprise partners to ensure accurate coding, support RPM initiatives, and contribute to process improvements across coding workflows.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing
• Associate degree in medical billing/coding, health insurance, healthcare or related field preferred

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD. Works independently across multiple MA/ESRD/ACA models.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Participates on ad-hoc projects to address department needs and process improvements.
• Engages in RPM Coding educational meetings and annual coding Summit.

Skills

Critical Thinking

Attention to Detail

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 in Pennsylvania seeks a skilled HCC coder to support risk adjustment projects for Medicare Advantage and ACA populations. You will translate physician documentation into ICD-10 diagnoses and HCC categories in line with CMS guidelines and RADV audit requirements.

You will collaborate with physicians, Quality, Compliance, and enterprise partners to ensure accurate coding, support RPM initiatives, and contribute to process improvements across coding workflows.