Remote HCC & Risk Adjustment Coding Specialist

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

Job summary

Highmark Inc. is seeking a skilled HCC coder to support risk adjustment coding for Medicare Advantage and ACA programs. You will apply ICD-10, HCC models, and CMS guidelines across RPM and non-RPM projects, ensuring accuracy and compliance.

Collaboration with physicians, Quality, Compliance, and enterprise partners is essential to improve documentation and coding quality. Required CPC/CRC/CCS/RHIT certifications and 3 years of HCC coding experience; preferred 5 years.

Qualifications

• 3 years HCC coding and/or coding and billing
• Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), RHIT
• Remote office-based work arrangement and travel up to 25%

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects; flexes across models and systems.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Participates on ad-hoc projects; provides recommendations for process improvements.
• Engages in RPM Coding educational meetings and annual coding Summit.
• Other duties as assigned.

Skills

HCC Coding

Attention to Detail

Critical Thinking

Written and Oral Presentation Skills

Written Communications

Communication Skills

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Education

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

Tools

MS Word

Excel

Outlook

PowerPoint

MS365 & Teams

Job description

Highmark Inc. is seeking a skilled HCC coder to support risk adjustment coding for Medicare Advantage and ACA programs. You will apply ICD-10, HCC models, and CMS guidelines across RPM and non-RPM projects, ensuring accuracy and compliance.

Collaboration with physicians, Quality, Compliance, and enterprise partners is essential to improve documentation and coding quality. Required CPC/CRC/CCS/RHIT certifications and 3 years of HCC coding experience; preferred 5 years.