Hierarchical Condition Category Coding Specialist

Highmark Health

. Perform HCC coding for Medicare Advantage, Affordable Care Act, and End Stage Renal Disease projects .

Posted 10/14/2026full-timeRemote • United StatesMid-LevelSenior💰 $27 - $42 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in HCC coding for Medicare Advantage, ACA, and ESRD projects, adhering to CMS guidelines while maintaining coding accuracy and productivity. Proficient in medical coding, clinical terminology, and regulatory audits, with strong collaboration and communication skills.

Highest-signal resume keywords

HCC CodingCertified Professional Coder (CPC)Certified Risk Coder (CRC)Risk Adjustment Data Validation (RADV) Audit KnowledgeCMS Coding Guidelines Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

HCC CodingMedical CodingClinical TerminologyAnatomy/Physiology KnowledgeCMS Coding GuidelinesRisk Adjustment Data Validation (RADV) Audit Knowledge

Soft Skills

Critical ThinkingAttention to DetailWritten Communication SkillsOral Presentation Skills

Tools & Technologies

MS WordExcelOutlookPowerPointMicrosoft Office SuiteMS365Teams

Certifications & Qualifications

Certified Professional Coder (CPC)Certified Risk Coder (CRC)Certified Coding Specialist (CCS)Registered Health Information Technician (RHIT)

Industry Keywords

Medicare AdvantageAffordable Care ActEnd Stage Renal DiseaseCoding ApplicationsElectronic Medical Record SystemsRegulatory AuditsCoding TeamsProcess ImprovementsRPM Coding

About the role

Key responsibilities & impact

Perform HCC coding for Medicare Advantage, Affordable Care Act, and End Stage Renal Disease projects
Flex between Retro and Prospective coding projects using different MA, ESRD, and ACA HCC models
Work independently in coding applications and electronic medical record systems
Follow CMS coding guidelines and Highmark policies and procedures
Maintain RPM coding accuracy and productivity requirements
Assist with regulatory audits through first coding review and chart ranking
Build partnerships and collaborate within coding teams and internal partners
Participate in ad-hoc departmental projects
Recommend process improvements and efficiencies
Engage in RPM coding educational meetings and the annual coding Summit
Perform other duties as assigned

Requirements

What you’ll need

3 years HCC coding and/or coding and billing experience required
One of the following certifications required: Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT)
HCC coding knowledge
Medical coding, clinical terminology, and anatomy/physiology knowledge
CMS coding guidelines knowledge
Risk Adjustment Data Validation (RADV) audit knowledge
Proficiency with MS Word, Excel, Outlook, PowerPoint, Microsoft Office Suite, MS365, and Teams
Critical thinking
Attention to detail
Written and oral presentation skills
Written communications and communication skills
No language other than English required

Benefits

Comp & perks

Remote work
Travel requirement of 0%–25%