Risk Adjustment Coding Specialist II

Astrana Health

Risk Adjustment Coding Specialist supporting physician practices remotely at Astrana Health. Conducting high-volume chart reviews and providing education to improve coding accuracy.

Posted 7/15/2026full-timeRemote • California • 🇺🇸 United StatesMid-LevelSenior💰 $70,000 - $85,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in risk adjustment coding, including ICD-10-CM and HCC, while providing education and training to healthcare providers. Proficient in auditing, compliance guidelines, and utilizing healthcare coding software and EHR systems.

Highest-signal resume keywords

Certified Professional Coder (CPC)Certified Risk Adjustment Coder (CRC)Risk Adjustment ExperienceProvider Education ExperienceHealthcare Coding Software Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10-CM CodingHCC CodingCode AbstractionCoding Quality AuditsAuditing AnalysisRoot-Cause AnalysisProcess ImprovementData DocumentationClaims CodingCompliance Guidelines

Soft Skills

Excellent Communication SkillsPresentation SkillsCollaborationTraining and MentoringProblem-Solving

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft OutlookMicrosoft PowerPointElectronic Health Records (EHR)

Certifications & Qualifications

Certified Professional Coder (CPC)Certified Risk Adjustment Coder (CRC)

Industry Keywords

Medicare AdvantageAffordable Care Act (ACO)Risk AdjustmentCoding RegulationsCompliance Guidelines

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

Certified Professional Coder (CPC) or CRC from AAPC
Certified Risk Adjustment Coder (CRC)** **certifications from AAPC
At least 3 years of experience in risk adjustment experience
At least 1 year experience with provider education
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.

Benefits

Comp & perks

This is a full-time position, operating M-F 830 AM - 5 PM EST.
This is a remote position. The home office is aligned at 1600 Corporate Center Drive, Monterey Park, CA. **We are seeking candidates who reside in CST or EST time zones.**
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.
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.