Risk Adjustment Coding Specialist II - Remote

Astrana Health, Inc.•Monterey Park, CA

16h•$70,000 - $85,000•Remote

About The Position

We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our IPAs across the nation. In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You’ll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you’ll track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success. We are seeking candidates who have experience with provider education and at least 3-5 years of risk adjustment experience!

Requirements

Must be open to traveling to provider sites within Connecticut and possibly surrounding areas. Reliable transportation and valid Driver’s License required
Certified Professional Coder (CPC) AND Certified Risk Adjustment Coder (CRC) certifications from AAPC
3-5+ years of experience in risk adjustment coding and billing experience
PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
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 softwares and Electronic Health Records (EHR) systems.
Strong knowledge with PowerPoint, preparing presentations, and public speaking
Strong experience with Excel - reports, pivot tables, VLOOKUP, etc.

Nice To Haves

Strong billing knowledge and/or Certified Professional Biller (CPB) through AAPC highly preferred
Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
Experience with multiple EMR/EHR systems
Experience with Monday.com and PowerBI
Ability to work independently and collaborate in a team setting
Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting

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
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.
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
Other duties as assigned