Remote HCC Coding Specialist: Risk Adjustment Expert

Highmark Health; Pennsylvania; Hybrid; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. is seeking an experienced HCC coder to support risk adjustment projects for MA, ACA and ESRD. You will translate physician documentation into ICD-10 diagnoses and HCC categories, work with physicians and teams to ensure accurate coding, and follow CMS guidelines and Highmark policies.

This remote, office-based role requires 3 years of HCC coding and/or coding and billing; Associate degree preferred. Travel 0–25% allowed.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing preferred
• Certification as CPC/CRC/CCS/RHIT preferred
• Strong knowledge of CMS guidelines and RPM coding

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects.
• Fl xes between models and coding applications, working independently.
• Adheres to CMS guidelines and Highmark policies.
• Maintains RPM coding accuracy and productivity requirements.
• Supports regulatory audits by performing first coding review.
• Builds partnerships with coding teams and internal partners.
• Participates in ad-hoc projects per leadership direction.
• Provides recommendations for process improvements and efficiencies.

Skills

Critical Thinking

Attention to Detail

Written Communications

Oral Communication

HCC Coding

MS Word

Excel

PowerPoint

Outlook

MS365 & Teams

Education

Associate degree in medical billing/coding

Tools

MS Word

Excel

Outlook

PowerPoint

Microsoft Office Suite

MS365 & Teams

Job description

Highmark Inc. is seeking an experienced HCC coder to support risk adjustment projects for MA, ACA and ESRD. You will translate physician documentation into ICD-10 diagnoses and HCC categories, work with physicians and teams to ensure accurate coding, and follow CMS guidelines and Highmark policies.

This remote, office-based role requires 3 years of HCC coding and/or coding and billing; Associate degree preferred. Travel 0–25% allowed.