Senior Coding Analyst, Risk Adjustment

Altais Health Solutions; Oakland (CA); On-site; USD 34,000 - 41,000; Full time

Job summary

Altais is seeking a Senior Coding Analyst, Risk Adjustment, to focus on HCC coding for Medicare Advantage programs and other risk-adjustment initiatives. You will train providers, ensure documentation aligns with ICD-10/HCC guidelines, and collaborate with physicians and clinical staff to optimize coding accuracy.

The role involves auditing, education, and support across IDV, RADV, OIG, and DMHC activities, with potential engagement across Commercial and Medicaid lines.

Qualifications

• Minimum 2 years of HCC coding experience.
• 3–5 years of professional medical coding experience (CPC/CRC or similar).
• 3–5 years in HCC coding and auditing (chart review).
• 1+ years in EPIC EMR software.
• 1+ years project management or coordinating detailed projects.

Responsibilities

• Review, audit, and code medical records for HCC reimbursement, training, and compliance.
• Meet daily productivity targets with 95% accuracy.
• Audit and review medical documentation for ICD-10 and HCC coding; query physicians when needed.
• Review codes annually for accuracy and implement changes.
• Assist physicians with questions on HCC coding and documentation.
• Support internal data validation, RADV, OIG, and DMHC audits.
• Serve as a resource to team members and physician offices.
• Role may allocate 50%+ of time to production.

Skills

HCC coding

Medical coding

Project coordination

Team collaboration

Education

High school diploma or GED

CPC/CRC certification

Bachelor’s degree preferred

Tools

EPIC EMR

Job description

About Altais:At Altais, we’re 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’re building a stronger, more connected healthcare system.About the RoleAre 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 organizations 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.You will focus on:The Coding Analyst is responsible for reviewing, auditing, and coding medical records for the purpose of HCC reimbursement, training, education, and complianceMeet daily productivity targets around HCC coding with 95% accuracy as well as office outreach and educationAudits and reviews medical documentation for appropriate ICD-10 and HCC coding and documentationQueries physicians when code assignments are not straightforward, or documentation is unclearReviews HCC and ICD-10 codes annually for accuracy and implements changesAssists physicians and providers with questions and problems related to HCC coding and documentationAssists physicians and providers with questions and problems related to coding and documentationSupports 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 membersServes as a resource to physician officesThis role may be responsible for 50% or more time meeting production standards.The Skills, Experience & Education You BringHigh school diploma or GED and equivalent of 2 years of relevant HCC coding experience3 - 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 software3 – 5 years’ experience in Medicare Risk Adjustment1 or more years’ project management and/or coordinating detailed projects or activitiesPreferred QualificationsBachelor’s degree from an accredited school6 or more years’ experience in a clinic setting, working directly with physicians and staff setting6 or more years’ experience and knowledge of Commercial and Medicaid coding, SDOH.The Compensation for this position is $24.88 to $29.86/hourIn addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.Excellent medical, vision, and dental coverage401k savings plan with a company matchFlexible time off and 9 Paid HolidaysYou Share Our Mission & Values:CompassionWe 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.CommunityWe 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.LeadershipWe 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.ExcellenceWe 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.AgilityWe 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.Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience.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 our ‘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.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. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.