Senior Risk Adjustment Coder & Auditor

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

Job summary

Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II to join the Quality - Risk Adjustment team in Orange, CA.

The role requires expertise in Medicare Advantage, ACA, and commercial risk adjustment coding, with significant travel to provider sites to support coding education and standards. The ideal candidate will hold CCS/CPC (AAPC/AHIMA) certification, have 3+ years of risk adjustment experience, and be proficient with EHR and coding software.

Qualifications

• Must possess and maintain AAPC or AHIMA certification – CCS and/or CPC. CRC is a plus but not required.
• 3+ years experience in risk adjustment coding and/or billing.
• Reliable transportation and ability to travel at least 75% of work time.
• Proficiency with Microsoft Word, Excel, and PowerPoint.
• 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 adjustment requirements.
• Assess and document HCC codes from medical records; ensure CMS risk adjustment guidelines compliance.
• Conduct coding audits to ensure ICD-10-CM codes are accurate and well-supported.
• Interact with physicians on coding, policies, and documentation issues.
• Meet productivity targets and deadlines; manage multiple priorities.

Skills

CCS/CPC

Travel readiness

MS Office

Communication

Tools

EHR software

Coding software

Job description

Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II to join the Quality - Risk Adjustment team in Orange, CA.

The role requires expertise in Medicare Advantage, ACA, and commercial risk adjustment coding, with significant travel to provider sites to support coding education and standards. The ideal candidate will hold CCS/CPC (AAPC/AHIMA) certification, have 3+ years of risk adjustment experience, and be proficient with EHR and coding software.