Remote HCC & Medical Coding Specialist (Risk Adjustment)

Highmark Health; Lansing (MI); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. is seeking a remote HCC coding specialist to support risk adjustment initiatives for MA and ACA programs.

You will translate physician documentation into ICD-10 codes and HCC categories, ensuring compliance with CMS guidelines and Highmark policies. In this role you will collaborate with physicians, Quality, Compliance, and leadership to improve documentation, accuracy, and audit readiness, while handling multiple coding projects across retro and prospective models.

Qualifications

• 3 years HCC coding and/or coding and billing.
• Preferred 5 years HCC coding and/or coding and billing.
• Certified Professional Coder (CPC) or Certified Risk Coder (CRC) or CCS or RHIT.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects.
• Adheres to CMS guidelines and Highmark policies in coding decisions.
• Supports RPM coding and regulatory audits; assists with process improvements.

Skills

Critical Thinking

Attention to Detail

Written Communications

Oral Presentation

HCC Coding

MS Word

Excel

PowerPoint

MS Teams

Education

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

Job description

Highmark Inc. is seeking a remote HCC coding specialist to support risk adjustment initiatives for MA and ACA programs.

You will translate physician documentation into ICD-10 codes and HCC categories, ensuring compliance with CMS guidelines and Highmark policies. In this role you will collaborate with physicians, Quality, Compliance, and leadership to improve documentation, accuracy, and audit readiness, while handling multiple coding projects across retro and prospective models.