[Hiring] Risk Adjustment Coding Specialist II @Astrana Health, Inc.

Role Description

We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our IPAs across the nation. In this role, you will support risk adjustment efforts by:

• Conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers.
• Translating findings into actionable insights and delivering education to providers and practice leaders.
• Tracking and reporting on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs.

Additionally, you will:

• Review provider documentation of diagnostic data from medical records to verify compliance with Medicare Advantage, ACO, and Commercial risk adjustment documentation requirements.
• Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to HCC.
• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
• Interact with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
• Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing.
• Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes.
• Provide recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
• Train, mentor, and support new employees during the orientation process.
• Provide peer-to-peer guidance through informal discussion and overread assignments.
• Assist or lead projects and/or handle a higher work volume than Risk Adjustment Coding Specialist I.
• Perform other duties as assigned.

Qualifications

• Must be open to traveling to provider sites within Connecticut and possibly surrounding areas.
• Reliable transportation and valid Driver’s License required.
• Certified Professional Coder (CPC) certification from AAPC.
• Certified Risk Adjustment Coder (CRC) certification from AAPC.
• 3-5+ years of experience in risk adjustment coding and billing experience.
• PC skills and experience using Microsoft applications such as Word, Excel, and Outlook.
• Excellent presentation, verbal and written communication skills, and ability to collaborate.
• Ability to educate and train provider office staff members.
• Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.
• Strong knowledge with PowerPoint, preparing presentations, and public speaking.
• Strong experience with Excel - reports, pivot tables, VLOOKUP, etc.

Requirements

• Strong billing knowledge and/or Certified Professional Biller (CPB) through AAPC highly preferred.
• Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage.
• Experience with multiple EMR/EHR systems.
• Experience with Monday.com and PowerBI.
• Ability to work independently and collaborate in a team setting.
• Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting.

Benefits

• The national target pay range for this role is $70,000 - $85,000 per year.
• Actual compensation will be determined based on geographic location, experience, and other job-related factors.
• This role will be fully remote and likely work in CST hours, with some work across time zones as necessary.
• This is a full-time position, M-F 8:30 AM - 5:00 PM.

Company Description

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need.

If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.