Remote HCC Risk Adjustment Coding Specialist (CPC/CRC)

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

Job summary

Highmark Health is seeking a remote HCC coder to support Medicare Advantage, ACA, and ESRD projects. You will apply ICD-10 diagnoses and HCC categories, align with CMS guidelines, and assist with RPM coding and audits. Collaboration with physicians, Quality, Compliance, and leadership is essential.

Required 3 years of HCC coding; CPC/CRC/CCS/RHIT certifications are preferred. This remote role involves travel up to 25% and emphasizes accuracy and process improvements.

Qualifications

• 3 years HCC coding and/or coding and billing
• Certification CPC, CRC, CCS, RHIT preferred or required
• Experience with CMS guidelines and RPM coding processes

Responsibilities

• Performs HCC coding on MA, ACA, ESRD projects across models and systems.
• Supports regulatory audits with initial chart review and ranking.
• Participates in ad-hoc projects and process improvement initiatives.
• Engages in RPM coding education and annual coding summits.

Skills

HCC Coding

Attention to Detail

Critical Thinking

Communication Skills

MS Word

MS Excel

MS Outlook

PowerPoint

Microsoft 365 & Teams

Written and Oral Presentation Skills

Written Communications

Education

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

Job description

Highmark Health is seeking a remote HCC coder to support Medicare Advantage, ACA, and ESRD projects. You will apply ICD-10 diagnoses and HCC categories, align with CMS guidelines, and assist with RPM coding and audits. Collaboration with physicians, Quality, Compliance, and leadership is essential.

Required 3 years of HCC coding; CPC/CRC/CCS/RHIT certifications are preferred. This remote role involves travel up to 25% and emphasizes accuracy and process improvements.