Risk Adjustment Coding Specialist I/II (Houston, TX)

Department: Quality - Risk Adjustment

Location: 19500 HWY 249, Suite 570 Houston, TX 77070

Compensation: $65,000 - $80,000 / year

Description

We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a 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 in the Texas area.

*Salary range and Level (I/II) will be determined based on experience and skills.

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 provider documentation of diagnostic data from medical record to verify that all Medicare Advantage 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
• Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
  
  

Qualifications

• Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - Certified Coding Specialist (CCS-P), CCS, or CPC. Certified Risk Adjustment Coder (CRC) is a plus
• Minimum of two years’ experience in medical coding
• Reliable transportation/Valid Driver’s License/Must be able to travel at least 75% of work time
• PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
• Excellent presentation, verbal and written communication skills, and ability to collaborate
• Must possess the ability to educate and train provider office staff members

You're great for this role if you have:

• Experience in medical billing and/or a certificate in billing
• Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
• Proficient experience with creating and presenting Powerpoint presentations
• Proficient experience with Excel - pivot tables, VLOOKUP, etc.
  
  

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. This position will require up to 75% travel to provider offices in the surrounding areas or home office, and the rest will be remote. The home office is located at 19500 TX-249, Suite 570, Houston, TX 77070.
• The work hours are Monday through Friday, 8:30am-5:00pm Central Time.
• The total pay range for this role is: $70,000 - $80,000 per year. This salary range represents our national target range for this role.

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 humanresourcesdept@astranahealth.com 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.