Risk Adjustment Coding Specialist II

🔥 26 minutes ago

🇺🇸 United States – Remote

💵 $70k - $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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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 provider documentation and diagnostic data from medical records to verify Medicare Advantage, Affordable Care Act (ACO), and Commercial risk adjustment documentation requirements • Deliver individual and group education to providers across managed IPAs • Review medical records retrospectively and prospectively to identify, assess, monitor, and document claims and encounter coding information related to HCCs • Perform code abstraction and coding quality audits to verify accurate ICD-10-CM coding and clinical documentation support • Interact with physicians regarding coding, billing, documentation policies, procedures, and ambiguous documentation • Prepare and perform auditing analysis and provide feedback on detected noncompliance • Maintain current knowledge of coding regulations, compliance guidelines, ICD-10 and HCC updates, and payer requirements • Recommend process improvements, root-cause analysis, and barrier resolution for Risk Adjustment initiatives • Train, mentor, and support new employees during orientation • Provide peer-to-peer guidance, informal discussion, and overread assignments • Support coder training and orientation as requested • Assist with or lead projects and higher work volumes than Risk Adjustment Coding Specialist I • Participate in department and provider meetings with the camera on • Perform other duties as assigned

🎯 Requirements

• Must possess and maintain AAPC certification, CPC • Additional CRC certification preferred • At least 3 years of experience in risk adjustment coding and/or billing required • At least 1 year of experience with targeted provider education • Reliable transportation and valid driver's license • Must be able to travel up to 75% of work time • PC skills and experience using Microsoft Word, Excel, and Outlook • Excellent presentation, verbal, and written communication skills • Ability to collaborate • Ability to educate and train provider office staff members • Proficiency with healthcare coding software and Electronic Health Records (EHR) systems • Strong billing knowledge and/or Certified Professional Biller (CPB) through AAPC • Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage • Strong PowerPoint and public speaking experience • Ability to work independently and collaborate in a team setting • Experience with Monday.com • Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting

🏖️ Benefits

• Remote position based in the U.S. • Up to quarterly travel to provider offices in Houston • Equal Employment Opportunity and Affirmative Action employer • Application accommodations available for candidates with disabilities