Remote Risk Adjustment HCC Coding Specialist

Highmark Health; Madison (WI); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. is seeking a skilled coder to support risk adjustment initiatives for MA, ACA, and ESRD programs.

The role involves translating physician documentation into ICD-10 diagnoses and HCC categories, using CMS guidelines and RADV audit awareness. You will collaborate with physicians, Quality, Compliance, and enterprise partners to deliver accurate coding, drive documentation improvement, and participate in RPM coding projects to meet CMS requirements.

Qualifications

• Minimum 3 years HCC coding and/or coding and billing required.
• 5 years HCC coding and/or coding and billing preferred.
• CPC, CRC, CCS, or RHIT certifications encouraged.

Responsibilities

• Perform HCC coding on MA, ACA, and ESRD projects.
• Adhere to CMS guidelines and Highmark policies.
• Support RPM coding and regulatory audits.
• Collaborate with physicians and teams to improve processes.

Skills

Critical Thinking

Attention to Detail

Written Communication

Communication Skills

HCC Coding

Education

Associate degree in medical billing or related field

Tools

MS Word

Excel

Outlook

PowerPoint

Job description

Highmark Inc. is seeking a skilled coder to support risk adjustment initiatives for MA, ACA, and ESRD programs.

The role involves translating physician documentation into ICD-10 diagnoses and HCC categories, using CMS guidelines and RADV audit awareness. You will collaborate with physicians, Quality, Compliance, and enterprise partners to deliver accurate coding, drive documentation improvement, and participate in RPM coding projects to meet CMS requirements.