Risk Adjustment Coding Specialist II

Astrana Health

. Conduct high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy .

Posted 10/9/2026full-timeMonterey Park • California • United StatesMid-LevelSenior💰 $80,000 - $85,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Risk Adjustment Coding, including ICD-10-CM compliance and HCC updates, while effectively educating and training healthcare providers. Proficient in analyzing coding gaps and trends to improve accuracy and performance metrics.

Highest-signal resume keywords

Risk Adjustment CodingICD-10-CM ComplianceCertified Coding Specialist (CCS-P)Healthcare Coding SoftwareHCC Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Risk Adjustment CodingICD-10-CM ComplianceCoding Quality AuditsCode AbstractionPerformance Metrics TrackingBilling KnowledgeRoot-Cause AnalysisDocumentation ReviewCoding EducationKPI Reporting

Soft Skills

Excellent Communication SkillsPresentation SkillsTraining and MentoringTeam CollaborationProblem-Solving

Tools & Technologies

Electronic Health Records (EHR)Microsoft WordMicrosoft ExcelMicrosoft OutlookMonday.comPowerPoint

Certifications & Qualifications

Certified Coding Specialist (CCS)Certified Professional Coder (CPC)Certified Risk Adjustment Coder (CRC)Certified Professional Biller (CPB)

Industry Keywords

Risk AdjustmentHierarchical Condition Categories (HCC)Medicare AdvantageAffordable Care Act (ACO)Coding RegulationsCompliance Guidelines

About the role

Key responsibilities & impact

Conduct high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy
Translate findings into actionable insights
Create and deliver education to providers and practice leaders
Track and report key performance metrics, including HCC recapture rates, AWVs, and other KPIs
Review provider documentation and diagnostic data to verify Medicare Advantage, Affordable Care Act (ACO), and Commercial risk adjustment requirements
Educate providers individually or in group forums
Review medical records retroactively and prospectively to identify, assess, monitor, and document claims and encounter coding information related to HCCs
Perform code abstraction and coding quality audits to ensure accurate ICD-10-CM coding and compliance with CMS Risk Adjustment guidelines
Interact with physicians regarding coding, billing, documentation policies, procedures, and ambiguous documentation
Prepare and perform auditing analysis and provide feedback on noncompliance issues
Maintain knowledge of coding regulations, compliance guidelines, ICD-10 and HCC updates, and payer requirements
Recommend process improvements, root-cause analysis, and barrier resolution for Risk Adjustment initiatives
Train, mentor, and support new employees during orientation
Provide peer-to-peer guidance and support coder training and orientation
Assist with or lead projects and higher work volumes than Risk Adjustment Coding Specialist I
Perform other duties as assigned

Requirements

What you’ll need

Must possess and maintain AAPC or AHIMA certification: Certified Coding Specialist (CCS-P), CCS, or CPC
At least 3 years of experience in risk adjustment coding and/or billing experience
Reliable transportation
Valid Driver’s License
Must be able to travel up to 75% of work time
PC skills and experience using Microsoft Word, Excel, and Outlook
Excellent presentation, verbal, and written communication skills
Ability to educate and train provider office staff members
Proficiency with healthcare coding software and Electronic Health Records (EHR) systems
Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
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 Monday.com
Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting

Benefits

Comp & perks

Hybrid work structure, working in the field and at home on a weekly basis
Up to 50% travel to provider offices in San Francisco, San Mateo, and Santa Clara
Equal Employment Opportunity and Affirmative Action employer
Reasonable accommodation available for applicants with disabilities