Certified Risk Coder

🔥 1 hour ago

🏄 California – Remote

🏄 California – Remote

💵 $56k - $85k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🎲 Risk

👻 Ghost score 0%

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Astrana Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

Astrana Health is a healthcare company that operates community-focused clinics and a provider-facing technology platform to coordinate care across primary, urgent, and multi-specialty services. It supports providers and local communities by streamlining access to care, automating prior authorizations, and connecting patients with in-network clinicians. Astrana combines clinical services with doctor-built technology to improve patient experience and provider workflows.

📋 Description

• Review medical records and provider documentation to ensure accurate capture of risk-adjusting diagnoses and compliance with CMS guidelines • Perform retrospective and prospective HCC coding reviews to identify documentation and coding opportunities • Validate ICD-10-CM codes and ensure diagnoses are clinically supported and accurately reported • Conduct coding audits and quality reviews to maintain documentation integrity and regulatory compliance • Partner with providers and clinical teams to improve documentation accuracy and risk adjustment performance • Deliver one-on-one and group education sessions on coding, documentation, and risk adjustment best practices • Communicate audit findings, coding trends, and improvement opportunities to providers and leadership • Stay current on ICD-10-CM, HCC, CMS Risk Adjustment, and payer-specific coding requirements • Support process improvement initiatives that enhance coding accuracy, compliance, and operational efficiency • Serve as a coding resource and mentor to team members, supporting training and knowledge sharing across the organization • Participate in special projects, departmental initiatives, and high-volume work efforts as assigned

🎯 Requirements

• Certified Risk Adjustment Coder (CRC) credential • At least two (2) years of risk adjustment, HCC coding, medical coding, or related healthcare experience • Working knowledge of Medicare Advantage Risk Adjustment and Hierarchical Condition Categories (HCC) • Proficiency with ICD-10-CM coding guidelines and CMS Risk Adjustment methodologies • Experience using Electronic Health Records (EHRs), coding software, and Microsoft Office applications • Excellent communication and presentation skills with the ability to educate providers and office staff • Strong analytical, organizational, and problem-solving skills with exceptional attention to detail • Ability to work independently in a remote environment while collaborating effectively with cross-functional teams • Active AAPC or AHIMA certification required (CPC, CCS-P, CCS, or equivalent) • Three (3)+ years of Risk Adjustment or Medicare Advantage coding experience • Experience conducting coding audits and documentation reviews • Experience educating providers on coding and documentation improvement initiatives • Previous experience supporting value-based care, population health, or provider group environments • Advanced presentation and PowerPoint skills

🏖️ Benefits

• Remote, US-based position • Strong preference for candidates based in West or Central time zones • Equal Employment Opportunity and Affirmative Action employer • Reasonable accommodation available for applicants with disabilities