The Role
Conduct high-volume chart reviews to identify HCC and ICD-10-CM coding gaps, audit and abstract codes, educate providers and practice leaders, track KPIs (HCC recapture, AWVs), mentor staff, recommend process improvements, and support risk adjustment initiatives.
Summary Generated by Built In
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. You’ll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you’ll track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.
We are seeking candidates who have experience with provider education and at least 3-5 years of risk adjustment experience!
Our Values:
We are seeking candidates who have experience with provider education and at least 3-5 years of risk adjustment experience!
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
- Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
- 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 Hierarchical Condition Categories (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 to ensure adherence with CMS Risk Adjustment guidelines
- Interacts 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, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
- Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
- Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
- Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
- May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
- 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) AND Certified Risk Adjustment Coder (CRC) certifications 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
- Must possess the ability to educate and train provider office staff members
- Proficiency with healthcare coding softwares and Electronic Health Records (EHR) systems.
- Strong knowledge with PowerPoint, preparing presentations, and public speaking
- Strong experience with Excel - reports, pivot tables, VLOOKUP, etc.
You're great for this role if:
- Strong billing knowledge and/or Certified Professional Biller (CPB) through AAPC highly preferred
- Have 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
Environmental Job Requirements and Working Conditions
- The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
- This role will be fully remote and likely work in CST hours, however, some work across time zones may be necessary.
- This is a full-time position, M-F 830-5.
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.
About
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Skills Required
- Willingness to travel to provider sites within Connecticut and surrounding areas; reliable transportation and valid Driver's License
- Certified Professional Coder (CPC) from AAPC
- Certified Risk Adjustment Coder (CRC) from AAPC
- 3-5+ years of risk adjustment coding and billing experience
- Proficiency with Microsoft Word, Excel, and Outlook
- Strong Excel skills including reports, pivot tables, VLOOKUP
- Experience preparing presentations and strong PowerPoint and public speaking skills
- 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 Record (EHR) systems
- Certified Professional Biller (CPB) through AAPC
- Experience with multiple EMR/EHR systems
- Experience with Monday.com
- Experience with PowerBI
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The Company
What We Do
Astrana Health is a physician-centric, technology-powered healthcare company that operates an integrated delivery platform. It enables providers to participate in value-based care arrangements, helping them deliver accessible, high-quality, and cost-effective care to patients. The company provides care coordination services to patients, primary care physicians, specialists, and health plans, leveraging proprietary technology to streamline operations and improve patient outcomes across local communities.
