Risk Adjustment Coding Specialist II Department: Quality - Risk Adjustment Employment Type: Full Time Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Reporting To: Yuvone Washington-Oshon Compensation: $70,0…
Skills: Risk Adjustment Coding, Medical Record Review, ICD-10-CM, Hierarchical Condition Categories, HCC
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$70k–$85k/yr
Full-time
professional certificate
Posted 6d ago
~40 hrs/week
Responsibilities
The specialist will review provider documentation to ensure compliance with Medicare Advantage and commercial risk adjustment requirements while delivering education to providers. They will also perform coding quality audits, identify diagnostic data gaps, and provide mentorship to staff.
Requirements
Candidates must hold an AAPC or AHIMA certification such as CCS or CPC and possess at least 3 years of experience in risk adjustment coding. The role requires a valid driver's license and the ability to travel to provider sites for approximately 75% of the work time.
Full job description
Risk Adjustment Coding Specialist II
Department: Quality - Risk Adjustment
Employment Type: Full Time
Location: 600 City Parkway West 10th Floor, Orange, CA 92868
Reporting To: Yuvone Washington-Oshon
Compensation: $70,000 - $85,000 / year
Description
We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry. The staff is required to frequently travel to provider sites depending on projects.
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
Meets or exceeds productivity targets as established by management. Regularly meets due dates assigned
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.
Keeps management apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.
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
Qualifications
Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification – Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC). Certified Risk Adjustment Coder (CRC) is a plus but not required
3+ years experience in risk adjustment coding and/or billing experience required
Reliable transportation/Valid Driver’s License/Must be able to travel at least 75% of work time
PC skills and experience using Microsoft applications such as Word, Excel, and PowerPoint
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 software and Electronic Health Records (EHR) systems.
You’re great for the role if:
Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
Ability to work independently and collaborate in a team setting
Strong organizational and time-management skills
Ability to work in a home office for continuous periods of time for business continuity
Ability to travel across the Provider Clinic service region for meetings and/or training as needed
Able to work independently and within time constraints
Able to efficiently prioritize multiple high-priority tasks
Environmental Job Requirements and Working Conditions
This position blends on-site fieldwork (approximately 75% travel) with remote support to help practices. The Company reserves the right to modify the work arrangement, including transitioning to a hybrid or onsite model, based on business needs. Disclaimer: This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities, duties, or qualifications required. Responsibilities may change based on business needs and organizational priorities.
The national target pay range for this role is $70,000 - $85,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
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.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Related keywords
Risk AdjustmentCoding SpecialistAAPCAHIMACCSCPCCRCICD-10-CMHCCMedicare AdvantageAffordable Care ActACOMedical RecordsClinical DocumentationAuditingProvider Education
Empowering physicians and providers to deliver high-quality, patient-centered care to all. (NASDAQ:ASTH)
Industry
Hospitals and Health Care
Company size
1,001-5,000 employees
Headquarters
Alhambra, California
LinkedIn followers
19,687
Total funding
$334M
Astrana Health is a physician-centric, technology-enabled healthcare company committed to delivering access to high-quality, patient-centered care. Through its proprietary end-to-end technology platform, Astrana empowers providers to deliver more proactive, preventive care - improving patient outcomes, elevating patient experiences, improving the well-being of providers, and driving greater value.
Today, Astrana supports more than 20,000 providers and over 1.6 million Americans in value-based arrangements through its affiliated provider networks, management services organization, and primary, specialty, and ancillary care delivery clinics.
Together, Astrana is building what our healthcare system should be - one that delivers better care, better experiences, and better outcomes for all. For more information, visit www.astranahealth.com.
Offices: Alhambra, California 91801, US · Las Vegas, Nevada 89148, US
Based on 11928 listings with disclosed salaries, most healthcare jobs in California pay between $84k–$230k per year. Individual offers vary with seniority, company size, and specialization.
How many Healthcare jobs are open in California right now?
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Are there remote or hybrid Healthcare jobs in California?
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