Risk Adjustment Coding Specialist II

Astrana Health; California (MO); Hybrid; USD 70,000 - 85,000; Full time

Job summary

Astrana Health is seeking a Risk Adjustment Coding Specialist to support Medicare Advantage, ACA, and Commercial coding initiatives. The role reports to the Sr. Manager - Risk Adjustment and requires frequent travel to provider sites.

Strong collaboration with physicians and staff is essential to ensure CMS guidelines are followed. Responsibilities include reviewing records for HCC coding, conducting audits, training staff, and providing process improvements.

Qualifications

• 3+ years experience in risk adjustment coding and/or billing required.

Responsibilities

• Review documentation to ensure Medicare Advantage, ACA, and Commercial risk adjustment requirements are met.

Skills

Communication skills

MS Office

Educate/train providers

Education

AAPC or AHIMA CCS/CPC

Tools

EHR systems

Microsoft Office

Job description

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Compensation: $70,000 - $85,000 / year

Department: Quality - Risk Adjustment

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Compensation: $70,000 - $85,000 / year

About the Role

We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry. The staff is required to frequently travel to provider sites depending on projects.

What You’ll Do

• Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
• Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
• Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
• Meets or exceeds productivity targets as established by management. Regularly meets due dates assigned
• Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
• Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
• Keeps management apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.
• Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
• Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
• Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
• May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I

Qualifications

• Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification – Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC). Certified Risk Adjustment Coder (CRC) is a plus but not required
• 3+ years experience in risk adjustment coding and/or billing experience required
• Reliable transportation/Valid Driver’s License/Must be able to travel at least 75% of work time
• PC skills and experience using Microsoft applications such as Word, Excel, and PowerPoint
• Excellent presentation, verbal and written communication skills, and ability to collaborate
• Must possess the ability to educate and train provider office staff members
• Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.

You’re great for the role if:

• Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
• Ability to work independently and collaborate in a team setting
• Strong organizational and time-management skills
• Ability to work in a home office for continuous periods of time for business continuity
• Ability to travel across the Provider Clinic service region for meetings and/or training as needed
• Able to work independently and within time constraints
• Able to efficiently prioritize multiple high-priority tasks

Environmental Job Requirements and Working Conditions

• This position blends on-site fieldwork (approximately 75% travel) with remote support to help practices. The Company reserves the right to modify the work arrangement, including transitioning to a hybrid or onsite model, based on business needs. Disclaimer: This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities, duties, or qualifications required. Responsibilities may change based on business needs and organizational priorities.
• The national target pay range for this role is $70,000 - $85,000. 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 Affliative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [e-mail] to request an accommodation.

Additional Information

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.