Remote HCC & Risk Adjustment Coding Specialist

Highmark Health; Minnesota; Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking a remote-office based HCC coding specialist to support Medicare Advantage, ACA, and RADV auditing with CMS guidelines. You will interpret clinical documents into ICD10 codes and HCC categories, collaborating with clinical teams, compliance, and leadership to improve accuracy and throughput.

The role emphasizes experience in HCC coding, familiarity with RPM projects, and ability to work across multiple coding systems, with 0–25% travel and remote-friendly logistics.

Qualifications

• 3 years HCC coding and/or coding and billing
• Experience with RPM coding
• Familiarity with CMS guidelines and RADV audits

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects with various HCC models
• Assists with Regulatory Audits through first coding review
• Participates in ad-hoc projects and process improvements
• Engages in RPM coding education and annual coding Summit
• Other duties as assigned

Skills

Critical Thinking

Attention to Detail

Written and Oral Presentation Skills

Written Communications

Communication Skills

HCC Coding

MS Word Excel Outlook PowerPoint

MS Office Suite Proficient

Education

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

Certified Professional Coder (CPC)

Certified Risk Coder (CRC)

Certified Coding Specialist (CCS)

Registered Health Information Technician (RHIT)

Tools

CMS Guidelines

Job description

Highmark Health is seeking a remote-office based HCC coding specialist to support Medicare Advantage, ACA, and RADV auditing with CMS guidelines. You will interpret clinical documents into ICD10 codes and HCC categories, collaborating with clinical teams, compliance, and leadership to improve accuracy and throughput.

The role emphasizes experience in HCC coding, familiarity with RPM projects, and ability to work across multiple coding systems, with 0–25% travel and remote-friendly logistics.