Remote HCC Coding Specialist - Risk Adjustment Expert

Highmark Health; Maryland City (MD); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking an experienced HCC coder to support risk adjustment coding for Medicare Advantage and ACA programs. You will work across MA, ACA, and ESRD projects, applying CMS guidelines and RPM considerations to ensure accurate ICD-10 and HCC coding.

The role involves collaboration with physicians, Compliance, Quality, and enterprise partners, with duties spanning audits, process improvements, and education on coding practices.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing (preferred)
• CPC/CRC/CCS/RHIT certifications required or preferred

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects across multiple models.
• Assists with regulatory audits by initial coding review and chart ranking.
• Participates in ad-hoc projects and suggests process improvements.
• 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

MS Excel

Outlook

PowerPoint

MS365 & Teams

Education

Associate degree in medical billing/coding or health-related field

Certified Professional Coder (CPC)

Certified Risk Coder (CRC)

Certified Coding Specialist (CCS)

Registered Health Information Technician (RHIT)

Tools

EMR systems

Coding applications

Job description

Highmark Health is seeking an experienced HCC coder to support risk adjustment coding for Medicare Advantage and ACA programs. You will work across MA, ACA, and ESRD projects, applying CMS guidelines and RPM considerations to ensure accurate ICD-10 and HCC coding.

The role involves collaboration with physicians, Compliance, Quality, and enterprise partners, with duties spanning audits, process improvements, and education on coding practices.