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Risk Adjustment Coding Specialist II

Astrana Health

Job Location:

California, CA - USA

Yearly Salary: USD 70000 - 85000

Posted: 5 August 2026 (30+ days ago)

Application Deadline: 1 December 2026

Vacancies: 1 Vacancy

Job Summary

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. The staff is required to frequently travel to provider sites depending on projects.

Our Values:

Put Patients First
Empower Entrepreneurial Provider and Care Teams
Operate with Integrity & Excellence
Be Innovative
Work As One Team

What Youll 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
Interacts with physicians regarding coding billing documentation policies procedures and conflicting/ambiguous or non-specific documentation
Meets or exceeds productivity targets as established by management. Regularly meets due dates assigned
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.
Keeps management apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.
Provides recommendations to management related to process improvements root-cause analysis and/or barrier resolution applicable to Risk Adjustment initiatives.
Trains mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
Provides peer to peer guidance through informal discussion and overread assignments. Supports 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 Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC). Certified Risk Adjustment Coder (CRC) is a plus but not required
3 years experience in risk adjustment coding and/or billing experience required
Reliable transportation/Valid Drivers License/Must be able to travel at least 75% of work time
PC skills and experience using Microsoft applications such as Word Excel and PowerPoint
Excellent presentation verbal and written communication skills and ability to collaborate
Must possess the ability to educate and train provider office staff members
Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.

Youre great for the role if:

Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
Ability to work independently and collaborate in a team setting
Strong organizational and time-management skills
Ability to work in a home office for continuous periods of time for business continuity
Ability to travel across the Provider Clinic service region for meetings and/or training as needed
Able to work independently and within time constraints
Able to efficiently prioritize multiple high-priority tasks

Environmental Job Requirements and Working Conditions

This position blends on-site fieldwork (approximately 75% travel) with remote support to help practices. The Company reserves the right to modify the work arrangement including transitioning to a hybrid or onsite model based on business needs. Disclaimer: This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities duties or qualifications required. Responsibilities may change based on business needs and organizational priorities.
The national target pay range for this role is $70000 - $85000. 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 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.

Required Experience:

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