Astrana Health
Risk Adjustment Coding Specialist II (SGV or IE, CA)
Astrana Health, Monterey Park, California, us, 91756
Overview
Risk Adjustment Coding Specialist II (San Gabriel Valley, CA) at Astrana Health Location:
1600 Corporate Center Dr., Monterey Park, CA 91754 Compensation:
$75,000 - $85,000 / year Department:
Quality - Risk Adjustment Description:
We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry.
Requires travel to provider sites in surrounding areas
May be open to considering Level I Specialists based on experience and skills
What You'll Do
Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) 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
Interact 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
Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes; stay informed about changes in Medicare, Medicaid, and private payer requirements
Provide recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives
Train, mentor and support new employees during the orientation process; function as a resource to existing staff for projects and daily work
Provide peer-to-peer guidance through informal discussion and overread assignments; support coder training and orientation as requested by manager
May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
Qualifications
Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - CCS-P, CCS, or CPC
3-5+ years of experience in risk adjustment coding and/or billing
Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
Reliable transportation/Valid Driver’s License; travel up to 75% of work time, if applicable
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
Bilingual in Chinese (Cantonese/Mandarin) is a plus
Certified Risk Adjustment Coder (CRC) and/or risk adjustment coding experience is desirable
Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage; strong PowerPoint and public speaking skills
Ability to work independently and collaborate in a team setting; experience with Monday.com is a plus
Experience educating and presenting to provider teams in person
Environment & Travel
The total pay range for this role is $75,000 - $85,000 per year.
Hybrid work structure with on-site and remote work; up to 75% travel to provider offices in the San Gabriel Valley area
Home office: 1600 Corporate Center Dr., Monterey Park, CA 91754
Work hours: Monday through Friday, standard business hours
Equal Opportunity 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 protected characteristics. All employment is decided on qualifications, merit, and business need.
If you require assistance in applying for open positions due to a disability, please email us at
humanresourcesdept@astranahealth.com
to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement and is subject to change by the employer as needs evolve.
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Risk Adjustment Coding Specialist II (San Gabriel Valley, CA) at Astrana Health Location:
1600 Corporate Center Dr., Monterey Park, CA 91754 Compensation:
$75,000 - $85,000 / year Department:
Quality - Risk Adjustment Description:
We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry.
Requires travel to provider sites in surrounding areas
May be open to considering Level I Specialists based on experience and skills
What You'll Do
Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) 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
Interact 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
Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes; stay informed about changes in Medicare, Medicaid, and private payer requirements
Provide recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives
Train, mentor and support new employees during the orientation process; function as a resource to existing staff for projects and daily work
Provide peer-to-peer guidance through informal discussion and overread assignments; support coder training and orientation as requested by manager
May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
Qualifications
Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - CCS-P, CCS, or CPC
3-5+ years of experience in risk adjustment coding and/or billing
Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
Reliable transportation/Valid Driver’s License; travel up to 75% of work time, if applicable
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
Bilingual in Chinese (Cantonese/Mandarin) is a plus
Certified Risk Adjustment Coder (CRC) and/or risk adjustment coding experience is desirable
Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage; strong PowerPoint and public speaking skills
Ability to work independently and collaborate in a team setting; experience with Monday.com is a plus
Experience educating and presenting to provider teams in person
Environment & Travel
The total pay range for this role is $75,000 - $85,000 per year.
Hybrid work structure with on-site and remote work; up to 75% travel to provider offices in the San Gabriel Valley area
Home office: 1600 Corporate Center Dr., Monterey Park, CA 91754
Work hours: Monday through Friday, standard business hours
Equal Opportunity 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 protected characteristics. All employment is decided on qualifications, merit, and business need.
If you require assistance in applying for open positions due to a disability, please email us at
humanresourcesdept@astranahealth.com
to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement and is subject to change by the employer as needs evolve.
#J-18808-Ljbffr