Remote HCC Coding Specialist - Risk Adjustment Expert

Highmark Health; Orangeburg (SC); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking a remote, office-based coder to deliver HCC coding services for MA, ACA, and ESRD projects. You’ll apply CMS guidelines and RADV processes to ensure accurate ICD10 diagnoses and HCC categorization, while supporting RPM initiatives and collaboration with physicians and cross-functional teams.

The role emphasizes regulatory compliance, documentation improvement, and process optimization to drive high-quality risk adjustment coding results across CMS programs.

Qualifications

• 3 years HCC coding and/or coding and billing.
• 5 years HCC coding and/or coding and billing.
• Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT) preferred.

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Participates on ad-hoc projects per the direction of Leadership to address department needs.
• 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

Excel

Outlook

PowerPoint

MS365 & Teams

Education

Associate degree in medical billing/coding

Tools

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Job description

Highmark Health is seeking a remote, office-based coder to deliver HCC coding services for MA, ACA, and ESRD projects. You’ll apply CMS guidelines and RADV processes to ensure accurate ICD10 diagnoses and HCC categorization, while supporting RPM initiatives and collaboration with physicians and cross-functional teams.

The role emphasizes regulatory compliance, documentation improvement, and process optimization to drive high-quality risk adjustment coding results across CMS programs.