Hierarchical Condition Category (HCC) Coding Specialist

Highmark Health•Carolina, PA

8d•Remote

About The Position

This role supports Health Plan beneficiaries enrolled in risk-adjusted government programs, including Medicare Advantage (MA), the Affordable Care Act (ACA), and End Stage Renal Disease (ESRD). The specialist applies HCC and medical coding knowledge, clinical terminology, anatomy and physiology, CMS coding guidelines, and Risk Adjustment Data Validation (RADV) audit practices to support accurate risk-adjustment coding. The position works with physicians, coding teams, Quality, Compliance, enterprise partners, and leadership. It supports Remote Patient Monitoring (RPM) risk-adjustment projects by analyzing physician documentation and translating it into ICD-10 diagnoses and HCC disease categories, as well as documentation improvement, provider education, report analysis, and process improvement. The position performs HCC coding across MA, ACA, and ESRD projects, including retrospective and prospective work using different HCC models. It uses coding applications and electronic medical record systems, supports regulatory audits, and contributes to coding education and departmental projects. The role is remote and office-based. The stated pay range is $27.02 to $41.85; the posting does not specify the pay period.

Requirements

At least 3 years of experience in HCC coding and/or coding and billing.
One of the following: Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT).
Critical thinking and attention to detail.
Written and oral presentation, written communication, and communication skills.
HCC coding skills.
Proficiency with Microsoft Office, including MS Word, Excel, Outlook, PowerPoint, MS365, and Teams.

Nice To Haves

Associate degree in medical billing/coding, health insurance, healthcare, or a related field.
5 years of experience in HCC coding and/or coding and billing.

Responsibilities

Perform HCC coding on projects for Medicare Advantage, ACA, and End Stage Renal Disease.
Flex between retrospective and prospective coding projects using different MA, ESRD, and ACA HCC models.
Work independently in coding applications and electronic medical record systems to support departmental goals.
Follow CMS coding guidelines and Highmark policies and procedures when making HCC coding decisions.
Meet RPM coding accuracy and productivity requirements.
Assist with regulatory audits by conducting initial coding reviews and ranking charts.
Build partnerships and work with coding teams and internal partners involved in HCC coding.
Participate in ad hoc projects at leadership’s direction.
Recommend process improvements and efficiencies.
Participate in RPM coding educational meetings and the annual coding Summit.
Perform other duties as assigned.
Protect confidential information and comply with HIPAA, company data security policies, the Code of Business Conduct, applicable laws, and required training.