Coding & Revenue Integrity Specialist

Astrana Health, Inc.; Nevada; Remote; USD 34,000 - 43,000; Full time

Job summary

Astrana Health, Inc. is seeking a skilled Coding & Revenue Integrity Specialist to support accurate, compliant revenue cycle performance across Medicare, Medicaid, and commercial payer lines.

The role focuses on provider documentation audits, risk adjustment validation (HCC), coding compliance, and ongoing education to improve reimbursement accuracy. This primarily remote position is based in Las Vegas, NV, with onsite quarterly meetings and education sessions as needed.

Qualifications

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
• 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 with Medicare, Medicare Advantage, Medicaid Managed Care, and Commercial payer programs preferred.

Responsibilities

• 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.

Skills

Medical coding proficiency

Auditing

Documentation accuracy

Risk adjustment knowledge

Regulatory compliance

Provider education

Analytical skills

Remote work capability

CMS/HIPAA knowledge

EHR familiarity

Education

High School Diploma or equivalent

Associate's or Bachelor's degree preferred

Tools

EHR platforms

Microsoft Office

eClinicalWorks (preferred)

Job description

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.