Revenue Integrity & Coding Specialist (Remote)

Astrana Health, Inc.; Nevada; A distancia; USD 34.000 - 43.000; Jornada completa

Descripción de la vacante

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.

Formación

• 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.

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.

Conocimientos

Medical coding proficiency

Auditing

Documentation accuracy

Risk adjustment knowledge

Regulatory compliance

Provider education

Analytical skills

Remote work capability

CMS/HIPAA knowledge

EHR familiarity

Educación

High School Diploma or equivalent

Associate's or Bachelor's degree preferred

Herramientas

EHR platforms

Microsoft Office

eClinicalWorks (preferred)

Descripción del empleo

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.