Hierarchical Condition Category (HCC) Coding Specialist
$27.02 per hourHighmark Health
Company : Highmark Inc. Job Description :
JOB SUMMARY
This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements.
ESSENTIAL RESPONSIBILITIES
- Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals. 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.
EDUCATION
Required
None
Substitutions
None
Preferred
Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.
EXPERIENCE
Required
- 3 years HCC coding and/or coding and billing
Preferred
- 5 years HCC coding and/or coding and billing
LICENSES or CERTIFICATIONS
Required (any of the following)
Certified Professional Coder (CPC)
Certified Risk Coder (CRC)
Certified Coding Specialist (CCS)
Registered Health Information Technician (RHIT)
Preferred
None
SKILLS
- Critical Thinking
- Attention to Detail
- Written and Oral Presentation Skills
- Written Communications
- Communication Skills
- HCC Coding
- MS Word, Excel, Outlook, PowerPoint
- Microsoft Office Suite Proficient/ - MS365 & Teams
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Remote Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Occasionally
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.Pay Range Minimum:
$27.02Pay Range Maximum:
$41.85Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
$60k - $65k
...Join 829’s thriving Paid Media team as a Paid Social Specialist. Continue your agency journey as you further develop your understanding... ...based on experience, demonstrated skills, and current market conditions at the time of hire to ensure fairness and consistency across...SuggestedTemporary workSummer workWork at officeLocal areaRemote work829 Studios
Wilmington, VT2 days ago- Thanx is hiring for a Merchant Operations role focused on ensuring partner setups, integrations, and ongoing health of loyalty, mobile apps, online ordering, and POS connections. You’ll work with Support, Customer Success, Implementation, Product, and Engineering, taking...SuggestedRemote work
Thanx
Wilmington, VT13 hours ago $25.16 - $31.45 per hour
...Benefits Eligibility Summary ( Job Summary: As an Events Specialist, you will be instrumental in leading a team focused on the daily... ...status protected by applicable law. Requisition ID 515508 Reference Date: 07/14/2026 Job Code Function: Brand & Experience...SuggestedFull timePart timeSeasonal workWork at officeLocal areaShift workVail Resorts
West Dover, VT1 day ago- Kaleida Health is seeking a Patient Registration Rep for the MFS Admissions department in Williamsville, NY. The role handles inpatient and outpatient scheduling, registration, and insurance verification, providing the first impression of Kaleida Health's services. Responsibilities...SuggestedBi-weekly payDaily paid
$49k - $56k
...Island, Pennsylvania, Delaware or District of Columbia. We are looking for a talented individual… To join our team as a Program Specialist! Program support staff ensure smooth delivery of projects and programs, both internally and externally; while adhering to program...SuggestedFull timeContract workLocal areaRemote work$88k - $164k
...Job Title: Senior Specialist, Internal Audit Job Code: 37513 Job Location: Melbourne, FL or Remote Opportunity Job Schedule: 9/80: Employees work 9 out of every 14 days – totaling 80 hours worked – and have every other Friday off Job Description...Full timeWork at officeRemote workFlexible hours$22.5 - $32.14 per hour
...regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, protected veteran status or any other status protected by applicable law. Requisition ID 515886 Reference Date: 07/14/2026 Job Code Function: Child Care...Full timeSeasonal workLocal areaShift work$22.5 - $32.14 per hour
...regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, protected veteran status or any other status protected by applicable law. Requisition ID 515886 Reference Date: 07/14/2026 Job Code Function: Child Care...Full timeSeasonal workLocal areaShift work$22 - $28.6 per hour
...regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, protected veteran status or any other status protected by applicable law. Requisition ID 517503 Reference Date: 09/11/2026 Job Code Function: Fitness/Spa...Full timePart timeSeasonal workWork at officeLocal areaShift workWeekend work$22 - $28.6 per hour
...and standards of operation. Comply with all state and national standards for Fitness Professions. Uphold the Professional Code of Ethics to the highest standard. Works well within the fitness center/spa team environment. Be able to maintain a regular...Part timeSeasonal workLocal areaShift work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Hierarchical Condition Category (HCC) Coding Specialist. Be the first to apply!
