Coding & Revenue Integrity Specialist
About The Position
Astrana Health is seeking a Coding & Revenue Integrity Specialist to support accurate, compliant, and optimized revenue cycle performance across Medicare, Medicare Advantage, Medicaid Managed Care, and Commercial payer lines. The role includes provider documentation audits, risk adjustment validation (HCC), coding compliance, provider education, and revenue integrity initiatives that support organizational performance and reimbursement accuracy. This is a primarily remote position based in Las Vegas, Nevada. Candidates must reside locally and be available to attend onsite meetings, provider education sessions, trainings, and operational activities quarterly or as needed. The position requires maintaining a secure, HIPAA-compliant home office.
Requirements
- High school diploma or equivalent required.
- At least 3–5 years of experience in medical coding, billing, auditing, revenue cycle management, or related healthcare operations.
- Strong knowledge of ICD-10-CM, CPT, HCPCS, modifier usage, medical terminology, and documentation standards.
- Knowledge of risk adjustment, HCC coding, provider documentation improvement, and compliance requirements.
- Experience conducting coding audits and providing provider education and feedback.
- Strong analytical, organizational, and problem-solving skills, with exceptional attention to detail.
- Proficiency with EHR platforms and Microsoft Office Suite.
- Ability to manage multiple priorities while working independently in a remote environment.
- Must reside within the Las Vegas, Nevada market and attend onsite activities as required.
- Must maintain a secure and HIPAA-compliant home office work environment.
- Required certification: Certified Professional Coder (CPC) through AAPC, or Certified Coding Specialist (CCS or CCS-P) through AHIMA.
Nice To Haves
- Associate's or Bachelor's degree.
- Experience supporting Medicare, Medicare Advantage, Medicaid Managed Care, and Commercial payer programs.
- Experience with eClinicalWorks.
- Certified Risk Adjustment Coder (CRC).
- Certified Professional Medical Auditor (CPMA).
- Certified Professional Biller (CPB).
- Certified Medical Reimbursement Specialist (CMRS).
Responsibilities
- Conduct prospective and retrospective chart audits to ensure coding accuracy, documentation integrity, and regulatory compliance.
- Assign ICD-10-CM, CPT, HCPCS, and modifier codes based on provider documentation and coding guidelines.
- Validate HCC and risk adjustment diagnoses and identify documentation opportunities that support accurate risk capture.
- Identify coding, documentation, and compliance gaps and provide actionable feedback to providers and operational teams.
- Perform routine coding audits, track findings and trends, and support corrective action initiatives.
- Deliver provider and staff education on documentation standards, coding requirements, compliance guidelines, and risk adjustment best practices.
- Support clean claim submission, denial prevention, revenue optimization, and resolution of coding-related billing issues.
- Collaborate with Revenue Cycle, Quality, Clinical Operations, and provider teams to improve workflows and revenue integrity outcomes.
- Assist with audit readiness activities and maintain compliance with CMS, payer, HIPAA, and organizational requirements.
- Contribute to process improvement initiatives that strengthen coding quality, reimbursement accuracy, and overall revenue cycle performance.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
