Risk Adjustment Coding Specialist II

Astrana Health

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

Posted 9/28/2026full-timeHouston • Texas • United StatesMid-LevelSenior💰 $70,000 - $85,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Risk Adjustment Coding, including ICD-10-CM coding and compliance with Medicare Advantage and ACO requirements. Proficient in delivering targeted provider education and conducting high-volume chart reviews to identify coding gaps and improve documentation accuracy.

Highest-signal resume keywords

AAPC Certification, CPCRisk Adjustment Coding ExperienceICD-10-CM Coding ProficiencyProvider Education DeliveryHealthcare Coding Software Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Risk Adjustment CodingICD-10-CM CodingCoding Quality AuditsChart Review AnalysisCode AbstractionPerformance Metrics TrackingDocumentation VerificationRoot-Cause AnalysisProcess ImprovementBilling Knowledge

Soft Skills

Excellent Communication SkillsPresentation SkillsCollaborationTraining and MentoringIndependent Work

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft OutlookElectronic Health Records (EHR)Monday.com

Certifications & Qualifications

AAPC Certification, CPCCertified Risk 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 provider accuracy
Translate chart-review findings into actionable insights
Create and deliver education to providers and practice leaders
Navigate complex conversations regarding coding and documentation
Track and report key performance metrics, including HCC recapture rates, AWVs, and other KPIs
Review provider documentation and medical records to verify Medicare Advantage, Affordable Care Act (ACO), and Commercial risk-adjustment requirements
Deliver individual and group provider education for managed IPAs
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 clinical-documentation support
Interact with physicians regarding coding, billing, documentation policies, procedures, and ambiguous documentation
Prepare and perform auditing analysis and provide feedback on noncompliance
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
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
Travel to provider offices twice weekly in the Houston area

Requirements

What you’ll need

Must possess and maintain AAPC certification, CPC
Additional CRC certification strongly preferred
At least 3 years of experience in risk adjustment coding and/or billing experience
At least 1 year of experience with targeted provider education
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
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
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 with work in the office, in the field, and at home on a weekly basis
Equal Employment Opportunity and Affirmative Action employer
Disability accommodation available during the application process