Remote Risk Adjustment Coding Specialist (HCC/CPC/CRC/CCS)

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

Job summary

Highmark Health is seeking a skilled HCC coder to support Medicare Advantage and ACA risk adjustment initiatives. You will interpret clinical documentation into ICD-10 and HCC diagnoses, working across RPM projects and CMS guidelines to ensure accurate coding.

Collaborate with physicians, Quality, Compliance, and enterprise partners to drive compliant risk adjustment, education, and process improvements. This remote role offers flexible scheduling and requires strong attention to detail.

Qualifications

• 3 years HCC coding and/or coding and billing experience.
• CPC, CRC, CCS and RHIT certifications required or equivalent.
• Knowledge of CMS Guidelines for Coding and RPM in risk adjustment.

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects with multiple models.
• Assist regulatory audits via first coding review and chart ranking.
• Participate in ad-hoc projects and provide process improvement ideas.
• Engage in RPM coding education meetings 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

MS365 & Teams

Education

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

Job description

Highmark Health is seeking a skilled HCC coder to support Medicare Advantage and ACA risk adjustment initiatives. You will interpret clinical documentation into ICD-10 and HCC diagnoses, working across RPM projects and CMS guidelines to ensure accurate coding.

Collaborate with physicians, Quality, Compliance, and enterprise partners to drive compliant risk adjustment, education, and process improvements. This remote role offers flexible scheduling and requires strong attention to detail.