Remote HCC Coding Specialist - Risk Adjustment Expert

Highmark Health; Milton (MA); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking a remote HCC coder to support Medicare Advantage, ACA, and ESRD coding projects. The role requires applying CMS guidelines, RADV audit preparation, and collaboration with physicians and care teams to ensure accurate risk adjustment coding.

Required credentials include CPC, CRC, CCS, and RHIT, with a minimum of 3 years of HCC coding experience. This position emphasizes accuracy, documentation improvement, and process efficiency across RPM initiatives.

Qualifications

• Three years HCC coding and/or coding and billing experience.
• Experience with CMS guidelines and RADV audits is a plus.
• Certifications CPC, CRC, CCS, RHIT are required or preferred.

Responsibilities

• Performs HCC coding for MA, ACA, and ESRD programs across multiple models.
• Supports regulatory audits by initial chart review and ranking.
• Collaborates with coding teams and internal partners to optimize accuracy and efficiency.
• Participates in RPM coding education sessions and coding summit.
• Other duties as assigned.

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 Health is seeking a remote HCC coder to support Medicare Advantage, ACA, and ESRD coding projects. The role requires applying CMS guidelines, RADV audit preparation, and collaboration with physicians and care teams to ensure accurate risk adjustment coding.

Required credentials include CPC, CRC, CCS, and RHIT, with a minimum of 3 years of HCC coding experience. This position emphasizes accuracy, documentation improvement, and process efficiency across RPM initiatives.