Remote HCC Coding Specialist – Risk Adjustment Expert

Highmark Health; Minneota (MN); Remote; USD 37.000 - 58.000; Vollzeit

Zusammenfassung

Highmark Health is seeking a risk-adjustment coder to deliver value to the Health Plan and beneficiaries enrolled in MA and ACA programs. The role uses HCC coding, clinical terminology, and CMS guidelines to interpret physician documentation into ICD10 diagnoses and HCC categories.

The position supports RPM risk-adjustment projects, audits, and education, partnering with physicians, Quality, Compliance, and leadership to improve documentation and coding accuracy.

Qualifikationen

• Preferred Associate degree in medical billing/coding or related field.
• 3 years HCC coding and/or coding and billing experience.
• CPC, CRC, CCS, RHIT certifications preferred.

Aufgaben

• Performs HCC coding on MA, ACA, and ESRD projects across models.
• Adheres to CMS guidelines and RPM coding accuracy standards.
• Assists with regulatory audits by initial chart review and ranking.
• Engages in RPM coding education meetings and coding summits.
• Supports ad-hoc projects and process improvements.

Kenntnisse

Critical Thinking

Attention to Detail

Written and Oral Presentation Skills

Written Communications

Communication Skills

HCC Coding

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Ausbildung

Associate degree in medical billing/coding, health insurance, healthcare or related field

Jobbeschreibung

Highmark Health is seeking a risk-adjustment coder to deliver value to the Health Plan and beneficiaries enrolled in MA and ACA programs. The role uses HCC coding, clinical terminology, and CMS guidelines to interpret physician documentation into ICD10 diagnoses and HCC categories.

The position supports RPM risk-adjustment projects, audits, and education, partnering with physicians, Quality, Compliance, and leadership to improve documentation and coding accuracy.