Risk Adjustment Coding Specialist II

Astrana Health

. Review provider documentation and diagnostic data from medical records to verify Medicare Advantage, Affordable Care Act (ACO), and Commercial risk adjustment documentation requirements .

Posted 10/6/2026full-timeRemote • 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 provider education, coding audits, and maintaining up-to-date knowledge of coding regulations and HCC updates.

Highest-signal resume keywords

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10-CM CodingRisk Adjustment CodingCoding Quality AuditsClaims DocumentationCoding AbstractionRoot-Cause AnalysisProcess ImprovementBilling KnowledgeHCC KnowledgeEHR Systems Proficiency

Soft Skills

Excellent Communication SkillsCollaboration AbilityPresentation SkillsTraining and MentoringIndependent Work Capability

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft OutlookMonday.comHealthcare Coding Software

Certifications & Qualifications

AAPC Certification, CPCCertified Risk Coder (CRC) PreferredCertified Professional Biller (CPB)

Industry Keywords

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

About the role

Key responsibilities & impact

Review provider documentation and diagnostic data from medical records to verify Medicare Advantage, Affordable Care Act (ACO), and Commercial risk adjustment documentation requirements
Deliver individual and group education to providers across managed IPAs
Review medical records retrospectively and prospectively to identify, assess, monitor, and document claims and encounter coding information related to HCCs
Perform code abstraction and coding quality audits to verify 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 detected noncompliance
Maintain current 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, informal discussion, and overread assignments
Support coder training and orientation as requested
Assist with or lead projects and higher work volumes than Risk Adjustment Coding Specialist I
Participate in department and provider meetings with the camera on
Perform other duties as assigned

Requirements

What you’ll need

Must possess and maintain AAPC certification, CPC
Additional CRC certification preferred
At least 3 years of experience in risk adjustment coding and/or billing required
At least 1 year of experience with targeted provider education
Reliable transportation and 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 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 AAPC
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

Remote position based in the U.S.
Up to quarterly travel to provider offices in Houston
Equal Employment Opportunity and Affirmative Action employer
Application accommodations available for candidates with disabilities