Quality Risk Adjustment Coder (San Gabriel Valley, CA)

DescriptionWe 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 San Gabriel Valley Area*May be open to considering Level I Specialists based on experience and skillsOur Values: Put Patients FirstEmpower Entrepreneurial Provider and Care TeamsOperate with Integrity & ExcellenceBe InnovativeWork As One TeamWhat 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 IQualificationsRequired 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 requiredStrong billing knowledge and/or Certified Professional Biller (CPB) through APPCReliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work time, if applicable.PC 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:    Bilingual in Chinese (Cantonese/Mandarin)Certified 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 settingEnvironmental Job Requirements and Working ConditionsThe total pay range for this role is $75,000 - $85,000 per year. This salary range represents our national target range for this role.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 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 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.

Salary : $75,000 - $85,000