Coding & Revenue Integrity Specialist

Astrana Health, Inc.; Las Vegas (NV); Teletrabalho; USD 34 000 - 43 000; Tempo integral

Resumo da oferta

Astrana Health is seeking a Coding & Revenue Integrity Specialist to ensure accurate coding and compliant revenue cycle across payer lines. You will perform provider documentation audits, validate HCCs, and educate providers on coding standards.

Based in Las Vegas area, this remote role requires onsite quarterly meetings and a local residence to attend sessions. You will collaborate with Revenue Cycle, Quality, and Clinical Operations to improve workflows and reimbursement accuracy.

Qualificações

• 3–5 years of experience in medical coding, billing, auditing or related healthcare operations.
• Strong knowledge of ICD-10-CM, CPT, HCPCS, modifier usage and documentation standards.

Responsabilidades

• Conduct prospective and retrospective chart audits to ensure coding accuracy, documentation integrity, and regulatory compliance.
• Accurately assign ICD-10-CM, CPT, HCPCS, and modifier codes based on provider documentation and coding guidelines.
• Validate HCC and Risk Adjustment diagnoses and identify documentation opportunities that support accurate risk capture.
• Identify coding, documentation, and compliance gaps and provide actionable feedback to providers and operational teams.
• Perform routine coding audits, track findings and trends, and support corrective action initiatives.
• Deliver provider and staff education on documentation standards, coding requirements, compliance guidelines, and risk adjustment best practices.
• Support clean claim submission, denial prevention efforts, revenue optimization, and resolution of coding-related billing issues.
• Collaborate with Revenue Cycle, Quality, Clinical Operations, and provider teams to improve workflows and revenue integrity outcomes.
• Assist with audit readiness activities and maintain compliance with CMS, payer, HIPAA, and organizational requirements.
• Contribute to process improvement initiatives that strengthen coding quality, reimbursement accuracy, and overall revenue cycle performance.

Conhecimentos

Medical coding

Auditing

HCC coding

Risk adjustment

Regulatory compliance

Provider education

EHR proficiency

Analytical skills

Remote work

Formação académica

Associate's or Bachelor's degree preferred

Ferramentas

EHR platforms (general)

Microsoft Office Suite

eClinicalWorks

Descrição da oferta de emprego

Coding & Revenue Integrity Specialist

Department: Billing - Central

Employment Type: Full Time

Location: 8880 W Sunset Rd, Suite 320, Las Vegas NV 89148

Reporting To: Angela Mangum

Compensation: $25.00 - $31.00 / hour

Description

Astrana Health is seeking a highly skilled Coding & Revenue Integrity Specialist to support accurate, compliant, and optimized revenue cycle performance across Medicare, Medicare Advantage, Medicaid Managed Care, and Commercial payer lines. This role is responsible for provider documentation audits, risk adjustment validation (HCC), coding compliance, provider education, and revenue integrity initiatives that drive organizational performance and reimbursement accuracy.

This is a primarily remote position based in Las Vegas, Nevada. Candidates must reside locally and be available to attend onsite meetings, provider education sessions, trainings, and operational activities on a quarterly basis or as needed.

Our Values:

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Conduct prospective and retrospective chart audits to ensure coding accuracy, documentation integrity, and regulatory compliance.
• Accurately assign ICD-10-CM, CPT, HCPCS, and modifier codes based on provider documentation and coding guidelines.
• Validate HCC and Risk Adjustment diagnoses and identify documentation opportunities that support accurate risk capture.
• Identify coding, documentation, and compliance gaps and provide actionable feedback to providers and operational teams.
• Perform routine coding audits, track findings and trends, and support corrective action initiatives.
• Deliver provider and staff education on documentation standards, coding requirements, compliance guidelines, and risk adjustment best practices.
• Support clean claim submission, denial prevention efforts, revenue optimization, and resolution of coding-related billing issues.
• Collaborate with Revenue Cycle, Quality, Clinical Operations, and provider teams to improve workflows and revenue integrity outcomes.
• Assist with audit readiness activities and maintain compliance with CMS, payer, HIPAA, and organizational requirements.
• Contribute to process improvement initiatives that strengthen coding quality, reimbursement accuracy, and overall revenue cycle performance.

Qualifications

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
• At least 3-5 years of experience in medical coding, billing, auditing, revenue cycle management, or related healthcare operations.
• Strong knowledge of ICD-10-CM, CPT, HCPCS, modifier usage, medical terminology, and documentation standards.
• Experience supporting Medicare, Medicare Advantage, Medicaid Managed Care, and Commercial payer programs preferred.
• Knowledge of risk adjustment, HCC coding, provider documentation improvement, and compliance requirements.
• Experience conducting coding audits and providing provider education and feedback.
• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.
• Proficiency with EHR platforms and Microsoft Office Suite; experience with eClinicalWorks preferred.
• Ability to manage multiple priorities while working independently in a remote environment.
• An authentic passion for operational excellence, compliance, and advancing value-based care initiatives.

Licenses/Certifications

• Certified Professional Coder (CPC) through AAPC
• OR
• Certified Coding Specialist (CCS or CCS-P) through AHIMA

Preferred

• Certified Risk Adjustment Coder (CRC)
• Certified Professional Medical Auditor (CPMA)
• Certified Professional Biller (CPB)
• Certified Medical Reimbursement Specialist (CMRS)

Environmental Job Requirements and Working Conditions

• This is a remote position supporting Astrana Health operations.
• Candidates must reside within the Las Vegas, Nevada market.
• Required onsite attendance for quarterly meetings, provider education sessions, trainings, and other operational activities as needed.
• Must maintain a secure and HIPAA-compliant home office work environment.
• Frequent computer use, auditing activities, and extended periods of reviewing electronic medical records are required.
• The target compensation range for this role is $25.00 - $31.00 per hour. Compensation may vary based on experience, certifications, education, skills, internal equity, and business needs.