Risk Adjustment Coding Specialist & Field Educator

Astrana Health, Inc.; Monterey Park (CA); Hybrid; USD 70,000 - 85,000; Full time

Job summary

Astrana Health is seeking a Risk Adjustment Coding Specialist to support our Orange County market. You will review charts, identify coding gaps, and educate providers to improve accuracy in HCC documentation, while tracking KPIs and guiding performance improvements.

The role requires up to 30% travel to provider offices and a CCS-P/CCS/CPC or equivalent certification with 3+ years of risk adjustment experience. A hybrid work structure is offered in California.

Qualifications

• Must have CCS-P/CCS/CPC certification or equivalent.
• 3+ years of risk adjustment coding or billing experience.
• Willingness to travel up to 75% of work time.
• Proficient with Microsoft Word, Excel, and Outlook.
• Excellent presentation and written communication skills; able to train providers.

Responsibilities

• Review provider documentation to verify Medicare Advantage, ACO, and Commercial risk adjustment requirements.
• Identify coding gaps and provide education to providers or groups.
• Perform code abstraction and audits to ensure ICD-10-CM codes match clinical documentation.
• Interact with physicians on coding, billing, and documentation policies.
• Prepare auditing analyses and provide feedback on noncompliance issues.
• Stay updated on ICD-10/HCC guidance and payer requirements.

Skills

Communication skills

Public speaking

Team collaboration

Educate/train providers

Education

AAPC/AHIMA certification (CCS-P/CCS/CPC)

3+ years risk adjustment coding experience

Tools

Microsoft Word

Microsoft Excel

Outlook

EHR systems

Healthcare coding software

Monday.com

Job description

Astrana Health is seeking a Risk Adjustment Coding Specialist to support our Orange County market. You will review charts, identify coding gaps, and educate providers to improve accuracy in HCC documentation, while tracking KPIs and guiding performance improvements.

The role requires up to 30% travel to provider offices and a CCS-P/CCS/CPC or equivalent certification with 3+ years of risk adjustment experience. A hybrid work structure is offered in California.