Risk Adjustment Coding Specialist II
A
Astrana HealthHealthcare
United States, CST or ESTFull-TimeMiddle
Salary70,000 - 85,000 USD per year
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Job Details
- Experience
- 3-5 years
- Required Skills
- Microsoft ExcelEHR
Requirements
- Certified Professional Coder (CPC) or CRC certification from AAPC.
- At least 3 years of experience in risk adjustment.
- At least 1 year of experience with provider education.
- Proficiency in Microsoft Word, Excel (including pivot tables and VLOOKUP), and Outlook.
- Strong presentation and public speaking skills.
- Proficiency with healthcare coding software and EHR systems.
- Strong knowledge of Hierarchical Condition Categories (HCC).
- Ability to work independently and collaboratively in a team environment.
- Experience collaborating with and educating provider teams.
Responsibilities
- Review provider documentation to ensure compliance with Medicare Advantage, ACO, and commercial risk adjustment requirements.
- Perform retroactive and prospective medical record reviews to document HCC coding information.
- Deliver provider education on an individual or group basis regarding documentation and coding accuracy.
- Assign and audit ICD-10-CM codes to ensure adherence to CMS guidelines.
- Analyze and report on key performance metrics including HCC recapture rates and AWVs.
- Provide recommendations to management regarding process improvements and barrier resolution.
- Train, mentor, and support new employees during orientation.
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