Risk Adjustment Educator & Coding Specialist II

Astrana Health, Inc.; Houston (TX); Hybrid; USD 70,000 - 85,000; Full time

Job summary

Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II to support Houston market. Travel to provider offices is required twice weekly, with responsibilities including chart reviews, HCC coding, and education delivery to providers.

Candidate will review documentation to ensure regulatory risk adjustment compliance and track KPIs like HCC recapture rates and AWVs. Experience with provider education and 3-5 years in risk adjustment is preferred.

Qualifications

• Must possess and maintain AAPC CPC and CRC certification.
• At least 3 years of risk adjustment coding and/or billing experience.
• Ability to travel up to 75% of work time and train provider staff.

Responsibilities

• Review provider documentation to verify Medicare, ACA, and commercial risk adjustment requirements and educate providers.
• Review medical records to identify HCC coding opportunities and ensure CMS guidelines adherence.
• Perform coding quality audits and provide feedback on noncompliance issues.
• Interact with physicians regarding coding, billing, and documentation policies.
• Maintain knowledge of ICD-10 and HCC updates and payer requirements.
• Provide recommendations for process improvements and training to staff.

Skills

Risk adjustment coding

CPC

CRC

Provider education

MS Office

Job description

Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II to support Houston market. Travel to provider offices is required twice weekly, with responsibilities including chart reviews, HCC coding, and education delivery to providers.

Candidate will review documentation to ensure regulatory risk adjustment compliance and track KPIs like HCC recapture rates and AWVs. Experience with provider education and 3-5 years in risk adjustment is preferred.