Risk Adjustment Coding Specialist - Hybrid

Quality Alhambra, California


Job Title: Risk Adjustment Coding Specialist - Hybrid 
Department: Quality - Risk Adjustment 

About the Role:

We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis. The staff is also required to frequently travel to provider sites depending on projects. Must be based in the Los Angeles area.

What You'll Do: 

  • Review provider documentation of diagnostic data from medical record to verify that all Medicare ACO, Medicare Advantage 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


  • Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - Certified Risk Adjustment Coder (CRC) & Certified Coding Specialist (CCS-P), CCS, CPC  
  • Minimum of two years’ experience in medical coding and billing for Medicare ACO, Medicare Advantage
  • 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 Outlook 
  • Excellent presentation, verbal and written communication skills, and ability to collaborate  
  • Must possess the ability to educate and train provider office staff members

You're great for this role if:     

  • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare ACO and Medicare Advantage. 
  • Have PowerPoint experience.

Who We Are   

Astrana Health (ASDAQ: 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 in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.   

Our platform currently empowers over 12,000 physicians to provide care for over 1.3 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 in order 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 main office is located in Alhambra. 
  • This position will require frequent traveling to provider offices. Must be available to travel 75% of work time. Offices are located in Alhambra, San Gabriel Area and Los Angeles areas. 
  • The shift will typically be on Monday - Fridays between 8:00 AM - 4:30 PM. 
  • The target pay range for this role is $25.00 - $35.00 per hour. This 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 [email protected] 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.