Senior Risk Adjustment Coder — Field Education & Analytics

Astrana Health, Inc.; Monterey Park (CA); Hybrid; USD 80,000 - 85,000; Full time

Job summary

Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II for the Northern California market.

This role will conduct high-volume chart reviews to identify coding gaps and drive education for providers, with travel to provider offices up to 50% of the time in San Francisco, San Mateo, and Santa Clara. You will review data to ensure Medicare Advantage, ACA, and Commercial risk adjustment documentation requirements are met, and report on KPIs like HCC recapture and AWVs.

Qualifications

• Must possess and maintain AAPC or AHIMA certification (CCS-P, CCS, or CPC).
• At least 3 years of risk adjustment coding experience.
• Willing to travel up to 75% of work time.
• Proficient with MS Word, Excel, Outlook; experience with EHR systems.

Responsibilities

• Review provider documentation to verify Medicare Advantage, ACA, and Commercial risk adjustment requirements and educate providers accordingly.
• Review medical records for HCC coding; identify trends and opportunities for improvement.
• Perform code abstraction and coding quality audits to ensure ICD-10-CM accuracy and CMS-compliance.
• Interact with physicians regarding coding, billing, and documentation policies.
• Provide auditing analyses and feedback on noncompliance; stay updated on coding regulations.

Skills

Risk adjustment coding

Education & training

Communication

Provider education

Attention to detail

Travel readiness

Education

CCS/P CPC certification

Tools

Word

Excel

Outlook

EHR systems

Job description

Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II for the Northern California market.

This role will conduct high-volume chart reviews to identify coding gaps and drive education for providers, with travel to provider offices up to 50% of the time in San Francisco, San Mateo, and Santa Clara. You will review data to ensure Medicare Advantage, ACA, and Commercial risk adjustment documentation requirements are met, and report on KPIs like HCC recapture and AWVs.