Remote HCC Coding Specialist — Risk Adjustment Expert

Highmark Health; Phoenix (AZ); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. in the United States seeks a Healthcare Risk Adjustment Coder to perform HCC coding for MA, ACA, and ESRD projects. You will work across retro and prospective models, applying CMS guidelines and Highmark policies to ensure accurate risk adjustment coding and compliance.

Ideal candidates have 3 years of HCC coding experience, relevant certifications, and proficiency with MS Office tools. This role offers remote office-based work with potential travel, and opportunities to contribute

Qualifications

• Performs HCC coding on projects for MA, ACA, and ESRD.
• FLEXES between Retro and Prospective models; uses various coding apps and EMR systems.
• Adheres to CMS Guidelines for Coding and Highmark’s policies.
• Maintains RPM coding accuracy and productivity requirements.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Supports RPM Coding educational meetings and annual coding Summit.

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD.
• Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models.
• Adheres to CMS Guidelines for Coding and Highmark’s Policy and Procedures.
• Maintains RPM coding accuracy and productivity requirements.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Build partnerships and work within coding teams and internal partners.
• Participates on ad-hoc projects per the direction of Leadership to address the needs of the department.
• Provides recommendations for process improvements and efficiencies.
• Engages in RPM Coding educational meetings and annual coding Summit.
• Other duties as assigned.

Skills

HCC Coding

Medical Coding

MS Word

Excel

PowerPoint

Outlook

MS Teams

Communication Skills

Education

Associate degree in medical billing / coding

Tools

MS Word

Excel

Outlook

PowerPoint

MS 365 & Teams

Job description

Highmark Inc. in the United States seeks a Healthcare Risk Adjustment Coder to perform HCC coding for MA, ACA, and ESRD projects. You will work across retro and prospective models, applying CMS guidelines and Highmark policies to ensure accurate risk adjustment coding and compliance.

Ideal candidates have 3 years of HCC coding experience, relevant certifications, and proficiency with MS Office tools. This role offers remote office-based work with potential travel, and opportunities to contribute