Remote HCC Coding Specialist: Risk Adjustment Pro

Highmark Health; Columbus (OH); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking a remote, office-based Coding Specialist focused on HCC coding for Medicare/ACA programs. You will apply CMS guidelines and RPM requirements to accurately translate physician documentation into ICD-10 and HCC categories, supporting audits and process improvements.

Requirements include 3 years of HCC coding experience and CPC, CRC, CCS, and RHIT certifications. Travel is minimal; remote work is supported. Strong analytical and communication skills are essential.

Qualifications

• 3 years HCC coding and/or coding and billing.
• 5 years HCC coding and/or coding and billing (preferred).
• Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects; flexes between models and uses multiple EMR/coding systems.
• Assists with regulatory audits by performing first coding review and ranking of charts.
• Participates in ad-hoc projects; provides recommendations for process improvements and efficiencies.
• Engages in RPM coding educational meetings and annual coding Summit.
• Other duties as assigned.

Skills

Critical Thinking

Attention to Detail

Written and Oral Presentation

Written Communications

Communication Skills

HCC Coding

MS Word, Excel, Outlook, PowerPoint

MS365 & Teams Proficiency

Education

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

Tools

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Job description

Highmark Health is seeking a remote, office-based Coding Specialist focused on HCC coding for Medicare/ACA programs. You will apply CMS guidelines and RPM requirements to accurately translate physician documentation into ICD-10 and HCC categories, supporting audits and process improvements.

Requirements include 3 years of HCC coding experience and CPC, CRC, CCS, and RHIT certifications. Travel is minimal; remote work is supported. Strong analytical and communication skills are essential.