Lead HCC Coding Specialist

Highmark Health

Lead HCC Coding Specialist supporting risk-adjusted government programs and compliance. Conducts audits, ensures coding accuracy, and provides team education and oversight.

Posted 5/22/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesSenior💰 $72,700 - $116,600 per yearWebsite

About the role

Key responsibilities & impact

Deliver value to the Health Plan and its beneficiaries enrolled in risk-adjusted government programs through HCC coding, medical coding, clinical terminology and anatomy/physiology
Conduct quality assurance (QA) review of internal coding team members
Provide coding education to team
Evaluate HCC coding questions and independently renders guidance on appropriate coding determinations
Supports RADV audits
Specializes in performing second level review of HCC validation
Prepares documentation and coversheets for upload to regulatory body and/or independent auditor
Analyzes results
Develop presentations to improve provider documentation and accuracy
Conducts Quality Assurance (QA) reviews on internal coders
Guides coding decision making adhering to CMS Guidelines for Coding and Highmark’s Policy and Procedures

Requirements

What you’ll need

Associate's degree in medical billing/coding, health insurance, healthcare or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree
5 years of HCC risk adjustment coding experience
7 years of HCC risk adjustment coding experience preferred
3 years of RADV audit experience
3 years of Coding QA experience
3 years of LPN or RN experience
1 years of Management or leadership
Certified Professional Coder (CPC) or Certified Risk Coder (CRC) or Certified Coding Specialist (CCS) or Registered Health Information Technician (RHIT) required

Benefits

Comp & perks

Health insurance
401(k) matching
Paid time off
Flexible work arrangements
Professional development opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

HCC codingmedical codingclinical terminologyanatomyphysiologyquality assurancecoding educationcoding determinationsRADV auditsprovider documentation

Soft Skills

guidancepresentation developmentteam leadership

Certifications

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