Risk Adjustment Coding Specialist II

Department: Quality - Risk Adjustment

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Compensation: $70,000 - $85,000 / year

Description

About the Role:
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. What You’ll Do:
• 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 • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation • Meets or exceeds productivity targets as established by management. Regularly meets due dates assigned
• 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.
• Keeps management apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.
• 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 I Qualifications:
• 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.
• Minimum of 3-5 years’ experience in risk adjustment coding and/or billing experience required
• Reliable transportation/Valid Driver’s License/Must be able to travel at least 75% of work time • PC skills and experience using Microsoft applications such as Word, Excel, and PowerPoint • 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.
You’re great for the role if:
• Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
• Ability to work independently and collaborate in a team setting
• Strong organizational and time-management skills
• Ability to work in a home office for continuous periods of time for business continuity
• Ability to travel across the Provider Clinic service region for meetings and/or training as needed
• Able to work independently and within time constraints
• Able to efficiently prioritize multiple high-priority tasks Who We Are:
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.
Our platform currently empowers over 10,000 physicians to provide care for ~1 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system. Our Values:
• Put Patients First • Empower Entrepreneurial Provider and Care Teams • Operate with Integrity & Excellence • Be Innovative • Work As One Team Environmental Job Requirements and Working Conditions:
• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Drive, Monterey Park, CA 91754
• This position will require frequent travel to provider offices in the surrounding areas. The position will require up to 75% travel.
• The total compensation target pay range for this role is: $______. The salary range represents our national target range for this role. 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.


What You'll Do

• 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
• Interacts 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.
• 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 I
• Other duties as assigned
  
  

Qualifications

• Required 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 required
• Reliable transportation/Valid Driver’s License/Must be able 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.

You're great for this role if:

• Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
• Certified Risk Adjustment Coder (CRC) and/or Risk Adjustment coding experience
• Have 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 Monday.com
• Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting
  
  
  
  

Environmental Job Requirements and Working Conditions

• The 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 up to 75% travel to provider offices in Orange County.

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.