Senior Hierarchical Condition Category (HCC) Coding Specialist

Highmark Health

HCC Coding Specialist analyzing medical records for Highmark’s Medicare Advantage and ACA risk-adjustment programs. Supporting CMS compliance, provider education, RADV audits, and coding quality.

Posted 9/3/2026full-timeRemote • Alabama, Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming • 🇺🇸 United StatesSenior💰 $68,400 - $105,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in HCC risk adjustment coding, including ICD-10 diagnoses and compliance with CMS requirements. Proficient in medical record reviews, provider education, and process improvement initiatives.

Highest-signal resume keywords

HCC Risk Adjustment CodingICD-10 Diagnosis InterpretationCertified Professional Coder (CPC)Strong Verbal And Written Communication SkillsProficiency In Microsoft Office Suite

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

HCC CodingMedical Record ReviewData AnalysisCoding Accuracy ImprovementProcess ImprovementProvider EducationQuality ReviewProject ManagementChronic Illness Clinical KnowledgeMedical Terminology

Soft Skills

Critical ThinkingAttention To DetailInterpersonal SkillsProblem SolvingCollaboration

Tools & Technologies

Microsoft Office SuiteMS365Microsoft Teams

Certifications & Qualifications

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

Industry Keywords

Medicare AdvantageAffordable Care ActCMS ComplianceHIPAA ComplianceRisk Adjustment Programs

About the role

Key responsibilities & impact

Deliver value to the Health Plan and beneficiaries enrolled in risk-adjusted government programs such as Medicare Advantage and Affordable Care Act programs
Analyze physician documentation and interpret it into ICD-10 diagnoses and HCC disease categories
Support risk adjustment projects in compliance with CMS requirements
Conduct medical record reviews and summarize opportunities to improve provider documentation and coding accuracy
Conduct quality reviews of high-risk and incremental HCCs
Collaborate on data collection, provider education and outreach, and coding quality
Develop and present process improvement and training initiatives
Analyze provider and provider-group coding trends and deliver external presentations
Serve as a point person for provider offices and provide additional training
Perform HCC coding for MA, ACA, and ESRD projects across Retro and Prospective models
Contribute to RADV audit coding reviews and chart submission preparation
Execute assigned projects and participate in ad-hoc projects
Mentor new hires and coworkers and develop onboarding and training materials
Support external vendor quality reviews and report findings

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 degree
3 year's in HCC risk adjustment coding experience
One of: Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT)
Critical thinking
Attention to detail
Strong verbal and written communication skills, including presentation skills
Ability to manage projects to a successful outcome
Strong interpersonal skills
Ability to identify and resolve problems
Ability to work in a fast-paced, collaborative environment with minimal supervision
Extensive knowledge of medical terminology and ability to research coding-related questions
Strong clinical knowledge related to chronic illness diagnosis, treatment, and management
Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, PowerPoint, MS365 and Teams
Compliance with HIPAA, data security guidelines, company policies, and applicable laws
Travel requirement: 0%–25%

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Highmark Health Website LinkedIn All Job Openings 10,000+ employees Founded 1852 🛡️ Insurance 💼 Consulting 📦 Logistics 💰 $5M Grant on 2021-05 Insurance
Consulting
Logistics Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike. Senior Hierarchical Condition Category (HCC) Coding Specialist Job not on LinkedIn 🔥 19 minutes ago 🏈 Alabama, Alaska, +45 more states – Remote 💵 $68.4k - $105.9k / year ⏰ Full Time 🟠 Senior 🏥 Medical Billing and Coding 🦅 H1B Visa Sponsor 👻 Ghost score 0% Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Deliver value to the Health Plan and beneficiaries enrolled in risk-adjusted government programs such as Medicare Advantage and Affordable Care Act programs
Analyze physician documentation and interpret it into ICD-10 diagnoses and HCC disease categories
Support risk adjustment projects in compliance with CMS requirements
Conduct medical record reviews and summarize opportunities to improve provider documentation and coding accuracy
Conduct quality reviews of high-risk and incremental HCCs
Collaborate on data collection, provider education and outreach, and coding quality
Develop and present process improvement and training initiatives
Analyze provider and provider-group coding trends and deliver external presentations
Serve as a point person for provider offices and provide additional training
Perform HCC coding for MA, ACA, and ESRD projects across Retro and Prospective models
Contribute to RADV audit coding reviews and chart submission preparation
Execute assigned projects and participate in ad-hoc projects
Mentor new hires and coworkers and develop onboarding and training materials
Support external vendor quality reviews and report findings 🎯 Requirements
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 degree
3 year's in HCC risk adjustment coding experience
One of: Certified Professional Coder (CPC), Certified Risk Coder (CRC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT)
Critical thinking
Attention to detail
Strong verbal and written communication skills, including presentation skills
Ability to manage projects to a successful outcome
Strong interpersonal skills
Ability to identify and resolve problems
Ability to work in a fast-paced, collaborative environment with minimal supervision
Extensive knowledge of medical terminology and ability to research coding-related questions
Strong clinical knowledge related to chronic illness diagnosis, treatment, and management
Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, PowerPoint, MS365 and Teams
Compliance with HIPAA, data security guidelines, company policies, and applicable laws
Travel requirement: 0%–25% Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Compliance Specialist – Coding 🔥 3 hours ago Appalachian Regional Healthcare (ARH) 5001 - 10000 🏥 Healthcare 🤝 Non-profit 📚 Education Website LinkedIn All Job Openings Compliance Specialist auditing coding and billing compliance for Appalachian Regional Healthcare. Developing audit plans, analyzing data, investigating risks, and recommending healthcare process improvements. 🇺🇸 United States – Remote 💰 $2.2M Grant on 2023-10 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🏥 Medical Billing and Coding Inpatient Medical Coder 🔥 15 hours ago Datavant 201 - 500 🏥 Healthcare 💼 Consulting ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Inpatient Medical Coder assigning ICD-10 and MS-DRG codes for Datavant’s healthcare data platform. Auditing coding quality and supporting documentation improvement remotely. 🇺🇸 United States – Remote 💵 $32 - $42 / hour 💰 $40M Series B on 2020-10 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🏥 Medical Billing and Coding 🦅 H1B Visa Sponsor Medical Coding Supervisor 🔥 18 hours ago Guidehouse 10,000+ employees 🏥 Healthcare 🎖️ Defense 📦 Logistics Website LinkedIn All Job Openings Medical Coding Supervisor overseeing inpatient, outpatient, and professional fee coding teams for Guidehouse. Training coders, reviewing quality, managing queues, and ensuring compliant medical coding. 🇺🇸 United States – Remote 💵 $61k - $101k / year 💰 Grant on 2023-02 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🏥 Medical Billing and Coding 🦅 H1B Visa Sponsor Hospital Coder – Outpatient 🔥 19 hours ago Sanford Health 10,000+ employees 🛡️ Insurance 🏥 Healthcare ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Hospital coder assigning outpatient diagnoses and procedure codes for Sanford Health’s rural U.S. health system. Applying ICD, CPT, EMR, and HIPAA expertise remotely. 🇺🇸 United States – Remote 💵 $20 - $33 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior 🏥 Medical Billing and Coding 🦅 H1B Visa Sponsor Medical Billing Specialist 🔥 20 hours ago American Health Partners 1001 - 5000 🏥 Healthcare ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Remote Medical Billing Specialist processing medical claims, payments, and insurance authorizations for American Health Partners. Managing patient accounts, denials, reconciliations, and collections. 🇺🇸 United States – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🏥 Medical Billing and Coding View More Medical Billing and Coding Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Remote jobs Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources About us Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass Resume Review AI Apply Copilot OpenClaw job finder API docs Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs