Senior Risk Adjustment Coding Specialist – Field Training

Astrana Health; San Diego (CA); Hybrid; USD 72,000 - 85,000; Full time

Job summary

Astrana Health in Orange, CA, seeks a Risk Adjustment Coding Specialist to support risk adjustment efforts through high-volume chart reviews, coding audits, and provider education.

The role involves traveling up to 75% to provider offices, maintaining CMS risk adjustment guidelines, and delivering insights to improve HCC recapture and KPIs. Strong communication and EHR proficiency are required.

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 required.
• Reliable transportation and ability to travel up to 75% of work time.
• Proficient in Word, Excel, Outlook; strong computer skills.

Responsibilities

• Review provider documentation to verify Medicare Advantage, ACA, and Commercial risk adjustment requirements.
• Review medical records to identify, assess, monitor, and document HCC coding.
• Perform code abstraction and audits to ensure ICD-10-CM codes are accurately assigned.
• Interacts with physicians regarding coding, billing, and documentation policies.
• Audit analysis and feedback on noncompliance issues; stay updated on ICD-10 and HCC codes.

Skills

Public speaking

Educate/train staff

Collaboration

Presentation skills

Education

AAPC or AHIMA CCS/CPC

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

EHR systems

Healthcare coding software

Job description

Astrana Health in Orange, CA, seeks a Risk Adjustment Coding Specialist to support risk adjustment efforts through high-volume chart reviews, coding audits, and provider education.

The role involves traveling up to 75% to provider offices, maintaining CMS risk adjustment guidelines, and delivering insights to improve HCC recapture and KPIs. Strong communication and EHR proficiency are required.