Remote Senior HCC Coding Specialist (Risk Adjustment)

Highmark Health; Pennsylvania; Hybrid; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a healthcare data coder to support risk adjustment coding for Medicare Advantage and ACA programs. This remote role emphasizes HCC coding, ICD-10, CMS guidelines, and RADV audits, while collaborating with quality and compliance teams to ensure accurate risk capture.

You will analyze medical records, mentor staff, develop training materials, and contribute to process improvements. The position requires 3 years of HCC experience and relevant certifications, along with

Qualifications

• Required Associate's degree in medical billing/coding, health insurance, healthcare or related field, or relevant experience and/or education as determined by the company in lieu of degree.
• 3 years' experience in HCC risk adjustment coding
• Certifications: CPC/CRC/CCS/RHIT are preferred
• Extensive knowledge of medical terminology and coding guidelines
• Strong communication and training skills

Responsibilities

• Conducts data analyses from medical records to improve coding accuracy.
• Mentors new hires and develops training materials.
• Performs HCC coding on MA, ACA, ESRD projects, and RADV audits.
• Delivers training and presents findings to internal and external stakeholders.
• Supports CMS guidelines adherence and risk adjustment processes.

Skills

Critical Thinking

Attention to Detail

Communication Skills

Presentation Skills

Project Management

Interpersonal Skills

Medical Terminology

MS Office

Education

Associate's degree

Tools

MS Word

Excel

PowerPoint

MS365

Teams

Job description

Highmark Health is seeking a healthcare data coder to support risk adjustment coding for Medicare Advantage and ACA programs. This remote role emphasizes HCC coding, ICD-10, CMS guidelines, and RADV audits, while collaborating with quality and compliance teams to ensure accurate risk capture.

You will analyze medical records, mentor staff, develop training materials, and contribute to process improvements. The position requires 3 years of HCC experience and relevant certifications, along with