Remote HCC Coding Specialist: Risk Adjustment Expert

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

Job summary

Highmark Inc. is seeking a remote Risk Adjustment Coder to deliver accurate HCC coding for MA, ACA and ESRD projects. The role requires working with physicians, quality teams, and enterprise partners to ensure compliant documentation and coding, while supporting RPM initiatives to meet CMS requirements.

Minimum 3 years of HCC coding experience with CPC/CRC/CCS/RHIT certifications. Remote position with travel 0-25% and strong expertise in ICD-10, HCC models, and CMS guidelines.

Qualifications

• 3 years HCC coding and/or coding and billing
• Associate degree in medical billing/coding preferred
• CPC, CRC, CCS, RHIT certifications required
• Proficient in medical terminology and MACRA/MQIA knowledge

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects and supports multiple models.
• Assists with regulatory audits through first coding review and chart ranking.
• Engages in RPM coding education and participates in coding Summits.
• Identifies process improvements and supports cross-functional teams.

Skills

Critical Thinking

Attention to Detail

Presentation Skills

Written Communications

Communication Skills

HCC Coding

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

CPC Certification

CRC Certification

CCS Certification

RHIT Certification

Associate degree in medical billing/coding

Tools

CMS Guidelines

Job description

Highmark Inc. is seeking a remote Risk Adjustment Coder to deliver accurate HCC coding for MA, ACA and ESRD projects. The role requires working with physicians, quality teams, and enterprise partners to ensure compliant documentation and coding, while supporting RPM initiatives to meet CMS requirements.

Minimum 3 years of HCC coding experience with CPC/CRC/CCS/RHIT certifications. Remote position with travel 0-25% and strong expertise in ICD-10, HCC models, and CMS guidelines.