Risk Adjustment Coding Specialist I

Astrana Health

Risk Adjustment Coding Specialist supporting risk adjustment efforts by conducting chart reviews and tracking performance metrics. Collaborating with providers to improve coding accuracy and program success.

Posted 6/24/2026full-timeRemote • Texas • 🇺🇸 United StatesMid-LevelSenior💰 $55,000 - $70,000 per yearWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - Certified Coding Specialist (CCS-P), CCS, or CPC.
At least 3 years of experience in risk adjustment coding and/or billing experience required.
Reliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work time.
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 software and Electronic Health Records (EHR) systems.

Benefits

Comp & perks

The national target pay range for this role is $55,000 - $70,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
This is a remote position. Candidates must live in an area within the central time zone.
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 humanresourcesdept@astranahealth.com to request an accommodation.
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.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

risk adjustment codingICD-10-CM codingcode abstractioncoding quality auditsclaims codingHCC codingauditing analysisroot-cause analysisprocess improvementsbilling experience

Soft Skills

presentation skillsverbal communicationwritten communicationcollaborationtrainingmentoringguidanceeducationsupportproblem-solving

Certifications

Certified Coding Specialist (CCS-P)Certified Coding Specialist (CCS)Certified Professional Coder (CPC)