Senior Coding Analyst, Risk Adjustment

Altais Health Solutions; California; Hybrid; USD 34,000 - 41,000; Full time

Benefits offered by this job

Excellent medical, vision, and dental

401k with company match

Flexible time off

9 paid holidays

Job summary

Altais Health Solutions is seeking a Senior Coding Analyst, Risk Adjustment to perform HCC coding and clinical documentation improvement for Medicare Advantage and related programs. The role collaborates with physicians, provider networks, and internal stakeholders to ensure accurate coding and readiness for CMS audits.

Responsibilities include analytics, education, and training for providers, with potential expansion to Commercial, Medicaid, and SDOH capture.

Qualifications

• 2+ years HCC coding experience and relevant credentialing.

Responsibilities

• Meet daily productivity targets around HCC coding with 95% accuracy.
• Audits and reviews medical documentation for ICD-10 and HCC coding.
• Query physicians when code assignments are unclear.
• Review HCC and ICD-10 codes annually for accuracy and update as needed.
• Assist physicians with questions about HCC coding and documentation.
• Support audits by internal and external teams (IDV, RADV, OIG, DMHC).
• Serve as a resource to team members and physician offices.
• May spend 50%+ time meeting production standards.

Skills

HCC coding

Medicare Risk Adjustment

Chart review

Project coordination

Education

Bachelor's degree

Tools

EPIC EMR

Job description

About Altais

At Altais, we are on a mission to improve the healthcare experience for everyone- starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we are building a stronger, more connected healthcare system.

About the Role

Are you looking to join a fast-growing, dynamic team? We're a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. The Senior Coding Analyst will divide their time coding medical records for the purpose of HCC coding, including our annual health assessments, and working with our physicians on clinical documentation improvement. The Senior Coding Analyst, Risk Adjustment provides support and coding expertise to all programs that support risk adjustment and data validation efforts for our Medicare Advantage line of business, along with other ad hoc and long-term projects assigned by the leadership team in Clinical Performance. These projects impact revenue and prepare us for health plan, CMS and HHS audits. The Senior Coding Analyst, Risk Adjustment will provide analytics, education, trainings to provider offices, and serve as the subject matter expert for all HCC coding initiatives, policies and procedures that adhere to our organization's coding guidelines and compliance standards. The position will interact with physicians, the provider network, and internal stakeholders within the organization (e.g. Provider Relations, Clinical Quality). The ability to develop and maintain key relationships across the company and provider network will be critical. The position may evolve to include Commercial, Medicaid, Quality and Social Determinants of Health (SDoH) capture as needed.

Key Responsibilities

• Meet daily productivity targets around HCC coding with 95% accuracy as well as office outreach and education
• Audits and reviews medical documentation for appropriate ICD-10 and HCC coding and documentation
• Queries physicians when code assignments are not straightforward, or documentation is unclear
• Reviews HCC and ICD-10 codes annually for accuracy and implements changes
• Assists physicians and providers with questions and problems related to HCC coding and documentation
• Assists physicians and providers with questions and problems related to coding and documentation
• Supports organization on all levels of HCC coding audits (Internal Data Validation (IDV), Risk Adjustment Data Validation (RADV), Office of Inspector General (OIG), Department of Managed Healthcare (DMHC))
• Serves as a resource to team members
• Serves as a resource to physician offices
• This role may be responsible for 50% or more time meeting production standards.

Skills, Experience & Education You Bring

• High school diploma or GED and equivalent of 2 years of relevant HCC coding experience
• 3 - 5 years' experience of professional medical coding credentials (CPC, CRC and or similar)
• 3 - 5 years' experience in HCC coding and auditing (chart review)
• 1 or more years' experience in EPIC EMR software
• 3 - 5 years' experience in Medicare Risk Adjustment
• 1 or more years' project management and/or coordinating detailed projects or activities
• Bachelor's degree from an accredited school (Preferred)
• 6 or more years' experience in a clinic setting, working directly with physicians and staff setting (Preferred)
• 6 or more years' experience and knowledge of Commercial and Medicaid coding, SDOH (Preferred)

Compensation

The Compensation for this position is $24.88 to $29.86/hour. In addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

Benefits

• Excellent medical, vision, and dental coverage
• 401k savings plan with a company match
• Flexible time off and 9 Paid Holidays

You Share Our Mission & Values

• Compassion - We act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity.
• Community - We foster a culture of collaboration - with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being.
• Leadership - We lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care.
• Excellence - We are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement.
• Agility - We embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront.

Equal Opportunity

All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity or disability status and any other classification protected by Federal, State and local laws.

Background Check

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance.

Privacy Notice

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to CPRA Privacy Notice for California Employees and Applicants to learn how we collect and process your personal information when you apply for a role with us.

Join Us

If you're a big thinker, bold innovator, and fiercely motivated to drive change, consider joining our team. We are dedicated to creating exceptional healthcare experiences by building tools that cultivate the health and well-being of physicians, patients, and the clinical community.