Job description
The Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines.
The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement.
Our Values:
Put Patients First
Empower Entrepreneurial Provider and Care Teams
Operate with Integrity & Excellence
Be Innovative
Work As One Team
What You'll Do
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
Qualifications
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
You are a great fit if
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
Environmental Job Requirements and Working Conditions
This is a Remote, US based position - Strong preference for candidates based in West or Central time zones
The annual total compensation target pay range for this role is $56,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors
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 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.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.