Remote HCC & Risk Adjustment Coding Specialist

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

Job summary

Highmark Health is seeking a skilled HCC Coder to support Medicare Advantage, ACA, and ESRD risk adjustment coding from a remote work setting. You will apply CMS guidelines to coding decisions and participate in RPM projects to ensure compliant documentation and accurate ICD10/HCC categorization.

Collaborate with physicians and cross-functional teams, maintain RPM coding accuracy, and contribute to process improvements and audits while meeting productivity targets.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects with multiple models and systems.
• Assists regulatory audits by performing first coding review and ranking of charts.
• Participates in ad-hoc projects and suggests process improvements.
• Engages in RPM coding education meetings and annual coding Summit.
• Other duties as assigned.

Skills

HCC Coding

Medical Coding

Attention to Detail

Communication Skills

CMS Guidelines

MS Word

MS Excel

MS Outlook

PowerPoint

MS Teams

Education

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

Tools

MS Word

MS Excel

MS Outlook

PowerPoint

MS Teams

MS365

Job description

Highmark Health is seeking a skilled HCC Coder to support Medicare Advantage, ACA, and ESRD risk adjustment coding from a remote work setting. You will apply CMS guidelines to coding decisions and participate in RPM projects to ensure compliant documentation and accurate ICD10/HCC categorization.

Collaborate with physicians and cross-functional teams, maintain RPM coding accuracy, and contribute to process improvements and audits while meeting productivity targets.