Risk Adjustment Coding Specialist II — Hybrid, Educate & Audit

Astrana Health

Houston (TX)

On-site

USD 70,000 - 85,000

Full time

9 days ago

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Job summary

Astrana Health in Houston, TX is seeking a Risk Adjustment Coding Specialist II to join the Quality - Risk Adjustment team. The role conducts provider medical record audits, analyzes coding patterns, and educates providers to ensure accurate CMS payment and quality care.

You will review ICD-10 and HCC codes, collaborate with physicians, perform audits, and support staff training. The position requires CPC and CRC, 3+ years experience in risk adjustment coding, travel up to 75%, and proficiency

Qualifications

Must hold AAPC CPC and CRC certifications.
Minimum 3 years of risk adjustment coding or billing experience.
At least 1 year of experience educating providers.
Must have reliable transportation and be able to travel up to 75%.
Proficient with Microsoft Office and EHR systems.
Excellent presentation, verbal and written communication, and collaboration skills.
Ability to educate and train provider office staff.

Responsibilities

Review provider documentation to verify Medicare Advantage, ACA, and Commercial risk adjustments.
Educate providers individually or in groups on coding and documentation.
Perform retroactive and prospective reviews of ICD-10-CM and HCC coding.
Interact with physicians on coding, billing, and documentation policies.
Prepare audits and provide feedback on noncompliance issues.
Stay current with ICD-10, HCC, CMS guidance, and payer requirements.
Offer process improvement recommendations to management.
Train and mentor new staff and support ongoing coder development.
Lead or assist with higher work volume as needed.