Job DescriptionJob DescriptionDescriptionWe are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Beaumont market. In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You’ll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you’ll track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.
We are seeking candidates who have experience with provider education and at least 3-5 years of risk adjustment experience! We are seeking candidates who reside in Houston and are able to travel to Beaumont on a monthly basis.
Our Values: Put Patients FirstEmpower Entrepreneurial Provider and Care TeamsOperate with Integrity & ExcellenceBe InnovativeWork As One Team
What You'll DoReview 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 companyReview 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 documentationPrepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditingMaintain 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 IOther duties as assigned
QualificationsRequired Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - Certified Coding Specialist (CCS-P), CCS, or CPC.3-5+ years of experience in risk adjustment coding and/or billing experience requiredReliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work timePC skills and experience using Microsoft applications such as Word, Excel, and OutlookExcellent presentation, verbal and written communication skills, and ability to collaborate Must possess the ability to educate and train provider office staff membersProficiency with healthcare coding software and Electronic Health Records (EHR) systems.You're great for this role if: Strong billing knowledge and/or Certified Professional Biller (CPB) through APPCCertified Risk Adjustment Coder (CRC) and/or Risk Adjustment coding experienceHave knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare AdvantageStrong PowerPoint and public speaking experienceAbility to work independently and collaborate in a team settingExperience with Monday.comExperience collaborating with, educating, and presenting to provider teams in a face-to-face setting
Environmental Job Requirements and Working ConditionsThe 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.This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. This position requires monthly travel to Beaumont from Houston.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.
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.
Read Less
