Remote Risk Adjustment HCC Coding Specialist

Highmark Health; Clifton (TX); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Health is seeking a remote-based HCC coder to support Medicare Advantage, ACA, and ESRD risk adjustment coding. You will work with physicians and teams to ensure accurate ICD-10 and HCC disease capture, while adhering to CMS guidelines and RPM requirements.

You will participate in audits, educate on coding standards, and contribute to process improvements across departments. A CPC/CRC/CCS/RHIT background and 3+ years of HCC coding are preferred.

Qualifications

• 3 years HCC coding and/or coding and billing
• 5 years HCC coding and/or coding and billing
• CPC, CRC, CCS, RHIT certifications are preferred
• Experience with regulatory audits and RPM coding

Responsibilities

• Performs HCC coding on MA, ACA, and ESRD projects across multiple models.
• Assist with regulatory audits via initial chart review and ranking.
• Participate in ad-hoc projects and suggest process improvements.
• Engage in RPM coding education meetings and coding Summit.
• Other duties as assigned.

Skills

Critical Thinking

Attention to Detail

Written Presentations

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

Tools

CMS Guidelines

Electronic Medical Records

Job description

Highmark Health is seeking a remote-based HCC coder to support Medicare Advantage, ACA, and ESRD risk adjustment coding. You will work with physicians and teams to ensure accurate ICD-10 and HCC disease capture, while adhering to CMS guidelines and RPM requirements.

You will participate in audits, educate on coding standards, and contribute to process improvements across departments. A CPC/CRC/CCS/RHIT background and 3+ years of HCC coding are preferred.