Remote HCC Coding Specialist – Risk Adjustment Expert

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

Job summary

Highmark Health in the United States seeks a skilled HCC Coder to deliver accurate risk adjustment coding for MA, ACA and ESRD programs, translating physician documentation into ICD-10 diagnoses and HCC categories in line with CMS guidelines.

This remote role collaborates with physicians, Quality, Compliance and leadership to support audits, RPM projects, education, and process improvements ensuring compliant, high‑quality coding.

Qualifications

• 3 years HCC coding and/or coding and billing.
• 5 years HCC coding and/or coding and billing.
• Credentials: CPC, CRC, CCS, RHIT (required; others preferred).
• Experience with CMS guidelines and RADV processes is a plus.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects, with Retro/Prospective models across MA/ESRD/ACA.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Participates on ad-hoc projects to improve department efficiency and accuracy.
• Engages in RPM coding educational meetings and annual coding Summit.
• Other duties as assigned.

Skills

HCC Coding

Attention to Detail

Critical Thinking

Written Communications

Communication Skills

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

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

Job description

Highmark Health in the United States seeks a skilled HCC Coder to deliver accurate risk adjustment coding for MA, ACA and ESRD programs, translating physician documentation into ICD-10 diagnoses and HCC categories in line with CMS guidelines.

This remote role collaborates with physicians, Quality, Compliance and leadership to support audits, RPM projects, education, and process improvements ensuring compliant, high‑quality coding.