Risk Adjustment Coding Specialist II; San Gabriel Valley, CA

Overview

Risk Adjustment Coding Specialist II (San Gabriel Valley, CA) at Astrana Health

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Compensation: $75,000 - $85,000 / year

Department: Quality - Risk Adjustment

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.

• Requires travel to provider sites in surrounding areas
• May be open to considering Level I Specialists based on experience and skills

• 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
• Interact 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
• Provide recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives
• Train, mentor and support new employees during the orientation process; function as a resource to existing staff for projects and daily work
• Provide peer-to-peer guidance through informal discussion and overread assignments; support coder training and orientation as requested by manager
• May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I

• Required Certification/Licensure:
  Must possess and maintain AAPC or AHIMA certification - CCS-P, CCS, or CPC
• 3-5+ years of experience in risk adjustment coding and/or billing
• Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
• Reliable transportation/Valid Driver’s License; travel up to 75% of work time, if applicable
• PC skills and experience using Microsoft Word, Excel, and Outlook
• Excellent presentation, verbal and written communication skills; ability to collaborate
• Ability to educate and train provider office staff members
• Proficiency with healthcare coding software and Electronic Health Records (EHR) systems
• Bilingual in Chinese (Cantonese/Mandarin) is a plus
• Certified Risk Adjustment Coder (CRC) and/or risk adjustment coding experience is desirable
• Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage; strong PowerPoint and public speaking skills
• Ability to work independently and collaborate in a team setting; experience with  is a plus
• Experience educating and presenting to provider teams in person

• The total pay range for this role is $75,000 - $85,000 per year.
• Hybrid work structure with on-site and remote work; up to 75% travel to provider offices in the San Gabriel Valley area
• Home office: 1600 Corporate Center Dr., Monterey Park, CA 91754
• Work hours:
  
  Monday through Friday, standard business hours

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 protected characteristics. All employment is decided on qualifications, merit, and business need.

If you require assistance in applying for open positions due to a disability, please email us at humanre to request an accommodation.

Additional Information: The job description does not constitute an employment agreement and is subject to change by the employer as needs evolve.