Certified Risk Coder
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Job Description
Certified Risk Coder reviewing medical records and validating HCC diagnoses for Astrana Health’s value-based care programs. Educating providers and improving coding compliance remotely.
Responsibilities:
- Review medical records and provider documentation to ensure accurate capture of risk-adjusting diagnoses and compliance with CMS guidelines
- Perform retrospective and prospective HCC coding reviews to identify documentation and coding opportunities
- Validate ICD-10-CM codes and ensure diagnoses are clinically supported and accurately reported
- Conduct coding audits and quality reviews to maintain documentation integrity and regulatory compliance
- Partner with providers and clinical teams to improve documentation accuracy and risk adjustment performance
- Deliver one-on-one and group education sessions on coding, documentation, and risk adjustment best practices
- Communicate audit findings, coding trends, and improvement opportunities to providers and leadership
- Stay current on ICD-10-CM, HCC, CMS Risk Adjustment, and payer-specific coding requirements
- Support process improvement initiatives that enhance coding accuracy, compliance, and operational efficiency
- Serve as a coding resource and mentor to team members, supporting training and knowledge sharing across the organization
- Participate in special projects, departmental initiatives, and high-volume work efforts as assigned
Requirements:
- Certified Risk Adjustment Coder (CRC) credential
- At least two (2) years of risk adjustment, HCC coding, medical coding, or related healthcare experience
- Working knowledge of Medicare Advantage Risk Adjustment and Hierarchical Condition Categories (HCC)
- Proficiency with ICD-10-CM coding guidelines and CMS Risk Adjustment methodologies
- Experience using Electronic Health Records (EHRs), coding software, and Microsoft Office applications
- Excellent communication and presentation skills with the ability to educate providers and office staff
- Strong analytical, organizational, and problem-solving skills with exceptional attention to detail
- Ability to work independently in a remote environment while collaborating effectively with cross-functional teams
- Active AAPC or AHIMA certification required (CPC, CCS-P, CCS, or equivalent)
- Three (3)+ years of Risk Adjustment or Medicare Advantage coding experience
- Experience conducting coding audits and documentation reviews
- Experience educating providers on coding and documentation improvement initiatives
- Previous experience supporting value-based care, population health, or provider group environments
- Advanced presentation and PowerPoint skills
Benefits:
- Remote, US-based position
- Strong preference for candidates based in West or Central time zones
- Equal Employment Opportunity and Affirmative Action employer
- Reasonable accommodation available for applicants with disabilities
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