Quality Risk Adjustment Coder; San Gabriel Valley, CA

Quality Risk Adjustment Coder (San Gabriel Valley, CA)

Location:

1600 Corporate Center Dr., Monterey Park, CA 91754

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

Department:
Quality - Risk Adjustment

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. The staff is required to frequently travel to provider sites depending on projects.

• Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACA) 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, and 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 – Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC). Certified Risk Adjustment Coder (CRC) is a plus but not required.
• 3‑5+ years of experience in risk adjustment coding and/or billing experience.
• Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC.
• Reliable transportation, valid driver’s license, and ability 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.

• Bilingual in Chinese (Cantonese/Mandarin).
• Certified Risk Adjustment Coder (CRC) and/or risk adjustment coding experience.
• Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage.
• Strong PowerPoint and public speaking experience.
• Ability to work independently and collaborate in a team setting.
• Experience with
• Experience collaborating with, educating, and presenting to provider teams in a face‑to‑face setting.

• The total pay range for this role is $75,000 - $85,000 per year.
• This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. The position requires up to 75% travel to provider offices in the surrounding areas. The home office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
• The work hours are 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 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 humanre to request an accommodation.