Certified Risk Coder

Astrana Health Management; Monterey Park, Northern (CA, KY); Hybrid; USD 56,000 - 85,000; Full time

Job summary

Astrana Health Management is seeking a Certified Risk Coder for a remote, US-based role to support value-based care and CMS risk adjustment initiatives. The successful candidate will review records, validate ICD-10-CM codes, and perform HCC coding analyses to improve documentation quality and compliance.

The ideal candidate holds a CRC credential, has 2+ years of risk adjustment experience, and excels in communication and educating providers.

Qualifications

• CRC credential required.
• 2+ years of risk adjustment or related coding experience.
• Experience with Medicare Advantage coding and HCC.
• Proficiency in ICD-10-CM coding guidelines and CMS risk adjustment methods.

Responsibilities

• Review medical records to capture risk-adjusting diagnoses and ensure CMS guidelines compliance.
• Perform retrospective and prospective HCC coding reviews to identify opportunities for improvement.
• Validate ICD-10-CM codes and ensure clinical support for diagnoses.
• Conduct coding audits and quality reviews to maintain documentation integrity.
• Educate providers and staff on coding and documentation best practices.
• Communicate audit findings and trends to providers and leadership.
• Stay current on ICD-10-CM, HCC, and payer-specific coding requirements.
• Support process improvements to enhance accuracy and efficiency.
• Mentor team members and participate in special projects.

Skills

CRC credential

Communication

Presentation

Remote work capability

Tools

EHRs

Coding software

Microsoft Office

Job description

Certified Risk Coder

Department: Quality - Risk Adjustment

Employment Type: Full Time

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Compensation: $56,000 - $85,000 / year

Description

The Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines.

The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement.

What You'll Do

• 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

Qualifications

• 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

You are a great fit if

• 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, and provider group environments
• Advanced presentation and PowerPoint skills

Environmental Job Requirements and Working Conditions

• This is a Remote, US based position - Strong preference for candidates based in West or Central time zones
• The annual total compensation target pay range for this role is $56,000 - $85,000 per year. 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 Aff