Certified Risk Coder Department
- Quality -
- Risk
- Adjustment
- Employment
- Type:
- Full
- Time
- Location: 1600 Corporate Center Dr.,
- Monterey
- Park,
- CA 91754
- Compensation: $56,000 - $85,000 / year
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
