Senior HCC Coding Specialist - Remote & Risk Adjustment

Highmark Health; Bozeman (MT); Remote; USD 37,000 - 58,000; Full time

Job summary

Highmark Inc. is seeking an experienced Risk Adjustment Coder to perform HCC coding for MA, ACA, and ESRD projects. You will navigate multiple models and EMR systems to support accurate risk adjustment coding while complying with CMS guidelines and Highmark policies.

The role requires 3 years of HCC coding and/or coding and billing experience, with a preference for 5 years. Remote office-based work with travel up to 25% may apply. Strong communication and analytical skills are essential.

Qualifications

• Required 3 years HCC coding and/or coding and billing
• Preferred 5 years HCC coding and/or coding and billing

Responsibilities

• Performs HCC coding on projects for MA, ACA, and ESRD.
• Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models.
• Adheres to CMS Guidelines for Coding and Highmark’s Policy and Procedures to guide HCC coding decision making.
• Maintains RPM coding accuracy and productivity requirements.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Build partnerships and work within coding teams and internal partners critical to HCC coding.
• Participates on ad-hoc projects per the direction of Leadership to address the needs of the department.
• Provides recommendations for process improvements and efficiencies.
• Engages in RPM Coding educational meetings and annual coding Summit.
• Other duties as assigned.

Job description

Highmark Inc. is seeking an experienced Risk Adjustment Coder to perform HCC coding for MA, ACA, and ESRD projects. You will navigate multiple models and EMR systems to support accurate risk adjustment coding while complying with CMS guidelines and Highmark policies.

The role requires 3 years of HCC coding and/or coding and billing experience, with a preference for 5 years. Remote office-based work with travel up to 25% may apply. Strong communication and analytical skills are essential.