Certified Coding Specialist I (Risk Adjustment)

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At UPMC Health Plan, we're looking for a detail-oriented Certified Coding Specialist I to join our Medicare HCC team. If you enjoy digging into medical records, applying your coding expertise, and making a meaningful impact on data accuracy and patient care-you'll feel right at home here.

This is a full-time, remote role working either 6:00 AM - 2:00 PM or 7:00 AM - 3:00 PM EST. If you're located in another time zone, you'll just need to be comfortable working these Eastern Time hours.

What You'll Do

In this role, you'll play a critical part in ensuring accurate coding and documentation across a variety of care settings. On a typical day, you'll:

• Review inpatient, outpatient, physician, and emergency department records to assign accurate diagnosis and procedure codes

• Apply your expertise in ICD-10-CM, CPT, and HCC risk adjustment coding to ensure proper classification of diagnoses

• Analyze documentation such as discharge summaries, H&Ps, progress notes, consults, and operative reports

• Identify and validate diagnoses submitted through claims by comparing them against clinical documentation

• Audit coding for accuracy and completeness before submission-and make corrections when needed

• Consistently meet quality (95% accuracy) and productivity standards

• Track and maintain your daily coding productivity and time logs

• Use coding tools, systems, and resources to work efficiently and accurately

How You'll Make an Impact

Your work will directly support accurate risk adjustment and data integrity across the health plan. You'll help ensure that diagnoses are properly captured, which ultimately supports better care planning, reporting, and outcomes.

What Helps You Succeed

• Strong knowledge of medical terminology, anatomy, physiology, and pathology

• Confidence working across multiple documentation types and care settings

• A keen eye for detail and commitment to accuracy

• The ability to manage your time independently in a remote environment

• A proactive mindset-you're comfortable identifying issues and helping improve processes

What Else to Expect

• Ongoing learning opportunities including coding education, seminars, and updated guidelines

• A collaborative team environment where your input and ideas are valued

• Monthly coding meetings to stay aligned and continuously improve

• A structured, process-driven environment with clear expectations and support

If you're ready to bring your coding expertise to a team that values accuracy, collaboration, and continuous improvement-we'd love to hear from you.

• Graduate of an AHIMA or AAPC Certified Coding Program that includes Anatomy & Physiology, Pharmacology and Medical Terminology.

• 5 years of total experience required.

• Five for more years or risk adjustment experience highly preferred.

• Knowledge of Microsoft Office.Licensure, Certifications, and Clearances:

• Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) required.

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran