Certified Risk Coder

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

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