Risk Adjustment Coding Specialist II

This is a fully remote position, open to applicants in California.

📋 Description

• Analyze provider documentation of diagnostic data from medical records to ensure compliance with all Medicare Advantage, Affordable Care Act (ACO), and Commercial risk adjustment documentation standards, while providing education to providers on an individual or group basis, as suited for all IPAs managed by the organization.

• Examine medical record information on both retrospective and prospective bases to identify, evaluate, monitor, and document claims and encounter coding details related to Hierarchical Condition Categories (HCC).

• Conduct code abstraction and/or coding quality audits of medical records to confirm the accurate assignment and support of ICD-10-CM codes in accordance with CMS Risk Adjustment guidelines.

• Engage with physicians concerning coding, billing, documentation policies, procedures, and any conflicting, ambiguous, or non-specific documentation.

• Prepare and/or conduct auditing analysis and provide feedback on compliance issues identified through audits.

• Stay updated on coding regulations, compliance guidelines, and changes to ICD-10 and HCC codes, as well as developments in Medicare, Medicaid, and private payer requirements.

• Offer recommendations to management related to process enhancements, root-cause analysis, and/or resolution of barriers relevant to Risk Adjustment initiatives.

• Train, mentor, and support new hires during the orientation process. Serve as a resource for existing staff on projects and daily tasks.

• Provide peer-to-peer guidance through informal discussions and overread assignments. Facilitate coder training and orientation as requested by the manager.

• May assist or lead projects and/or handle a higher workload than a Risk Adjustment Coding Specialist I.

• Perform other duties as assigned.

⛳️ Requirements

• Willingness to travel to provider sites within Connecticut and potentially surrounding areas. Reliable transportation and a valid Driver’s License are 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.

• Proficient in PC skills and experienced with Microsoft applications such as Word, Excel, and Outlook.

• Exceptional presentation, verbal and written communication skills, along with the ability to collaborate effectively.

• Capable of educating and training provider office staff members.

• Proficient with healthcare coding software and Electronic Health Records (EHR) systems.

• Strong knowledge of PowerPoint, including preparing presentations and public speaking.

• Extensive experience with Excel, including reports, pivot tables, VLOOKUP, etc.

🏝️ Benefits

• The national target pay range for this position 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 position is fully remote and will likely operate in CST hours, although some work across time zones may be required.

• This is a full-time role, Monday to Friday, from 8:30 AM to 5:00 PM.

• Astrana Health is committed to being an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on 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 any other legally protected characteristics. All employment decisions are made based on qualifications, merit, and business needs. If you need assistance in applying for open positions due to a disability, please email us at **humanresourcesdept@astranahealth.com** to request an accommodation.