Senior Risk Adjustment Coder & Trainer (Hybrid)

Astrana Health; Orange (CA); Hybrid; USD 70,000 - 85,000; Full time

Job summary

Astrana Health is seeking a Risk Adjustment Coding Specialist to support Orange County operations. You will conduct high-volume chart reviews to identify coding gaps, then translate findings into education for providers and practice leaders, driving HCC recapture and KPI improvements.

olla You will travel to provider offices up to 75% and collaborate with IPA teams, offering auditing and education to ensure CMS, Medicare and payer guidelines are met while staying current on ICD-10/HCC updates.

Qualifications

• Must possess and maintain AAPC or AHIMA certification - CCS-P, CCS, or CPC.
• At least 3 years of experience in risk adjustment coding and/or billing.
• Reliable transportation and ability to travel up to 75% of work time.
• PC skills and experience using Microsoft Word, Excel, and Outlook.
• Excellent presentation, verbal and written communication skills; ability to educate provider staff.

Responsibilities

• Review provider documentation of diagnostic data to verify Medicare Advantage, ACA and Commercial risk adjustment documentation requirements and deliver education to providers.
• Review medical record information to identify, assess, monitor, and document HCC-related coding information.
• Perform code abstraction and/or coding quality audits to ensure ICD-10-CM codes are accurate and well-supported by documentation.
• Interact with physicians regarding coding, billing, and documentation policies and procedures.
• Prepare or perform auditing analyses and provide feedback on noncompliance issues.
• Maintain knowledge of coding regulations and updates to ICD-10 and HCC codes; stay informed about payer requirements.
• Provide recommendations to management on process improvements and barrier resolution for Risk Adjustment initiatives.
• Train, mentor and support new employees; act as a resource to staff for projects and daily work.
• Offer peer-to-peer guidance and overread assignments; support coder training as requested.
• May assist or lead projects and handle higher work volumes.
• Other duties as assigned.

Skills

Public speaking

PowerPoint

Educating providers

Training staff

Communication

Education

AAPC or AHIMA certification

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Monday.com

EHR systems

Job description

Astrana Health is seeking a Risk Adjustment Coding Specialist to support Orange County operations. You will conduct high-volume chart reviews to identify coding gaps, then translate findings into education for providers and practice leaders, driving HCC recapture and KPI improvements.

olla You will travel to provider offices up to 75% and collaborate with IPA teams, offering auditing and education to ensure CMS, Medicare and payer guidelines are met while staying current on ICD-10/HCC updates.