Risk Adjustment Coding Specialist II

Astrana Health, Inc.•Orange, CA

8d•$70,000 - $85,000•Hybrid

About The Position

We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry. The staff is required to frequently travel to provider sites depending on projects. The national target pay range for this role is $70,000 - $85,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation. The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Requirements

Must possess and maintain AAPC or AHIMA certification – Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC).
3+ years experience in risk adjustment coding and/or billing experience required
Reliable transportation/Valid Driver’s License/Must be able to travel at least 75% of work time
PC skills and experience using Microsoft applications such as Word, Excel, and PowerPoint
Excellent presentation, verbal and written communication skills, and ability to collaborate
Must possess the ability to educate and train provider office staff members
Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.

Nice To Haves

Certified Risk Adjustment Coder (CRC) is a plus but not required
Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
Ability to work independently and collaborate in a team setting
Strong organizational and time-management skills
Ability to work in a home office for continuous periods of time for business continuity
Ability to travel across the Provider Clinic service region for meetings and/or training as needed
Able to work independently and within time constraints
Able to efficiently prioritize multiple high-priority tasks

Responsibilities

Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
Meets or exceeds productivity targets as established by management. Regularly meets due dates assigned
Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
Keeps management apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.
Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I