Remote HCC Coding Specialist & Training Lead

Highmark Health; Northern (KY); Hybrid; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking an experienced HCC risk adjustment coder to translate provider documentation into ICD-10/ HCC diagnoses and support RADV audits across MA and ACA. The role requires working remotely with flexibility to travel up to 25%.

You will collaborate with quality, compliance, and physicians, mentor new hires, and develop training materials while adhering to CMS guidelines and Highmark policies.

Qualifications

• Associate degree in medical billing/coding or related field.
• 3+ years of HCC risk adjustment coding experience.
• Certification options include CPC/CRC/CCS/RHIT preferred

Responsibilities

• Analyze medical records to improve coding accuracy and capture chronic conditions.
• Conduct quality reviews of high-risk HCCs and support CMS guidelines.
• Develop training and present to internal teams and provider offices.
• Mentor new hires on CMS and Highmark coding guidelines.
• Support RADV audits and data validation reviews.
• Collaborate with cross-functional teams on coding projects.

Skills

Critical Thinking

Attention to Detail

Verbal and Written Communication

Project Management

Interpersonal Skills

Medical Terminology

Chronic Illness Knowledge

Microsoft Office

Education

Associate's degree in medical billing/coding

Tools

MS Word

Excel

Outlook

PowerPoint

MS365

Teams

Job description

Highmark Health is seeking an experienced HCC risk adjustment coder to translate provider documentation into ICD-10/ HCC diagnoses and support RADV audits across MA and ACA. The role requires working remotely with flexibility to travel up to 25%.

You will collaborate with quality, compliance, and physicians, mentor new hires, and develop training materials while adhering to CMS guidelines and Highmark policies.