Risk Adjustment Coding Specialist I - Remote (Central Time Zone)

Risk Adjustment Coding Specialist II - Houston Department: Quality - Risk Adjustment Employment Type: Full Time Location: 19500 HWY 249, Suite 570 Houston, TX 77070 Reporting To: Chanell Graves Compensation: $70,000 - $85,000 / year Description We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Houston market. In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You’ll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you’ll track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success. We are seeking candidates who have experience with provider education and at least 3-5 years of risk adjustment experience! This position requires travel to provider offices up to 75% of the time in the Houston area. 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 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 Interact 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 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 Provide recommendations to management related to process improvements, root‑cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives Train, mentor and support new employees during the orientation process; function as a resource for existing staff on projects and daily work Provide peer‑to‑peer guidance through informal discussion and overread assignments; support coder training and orientation as requested by manager Assume responsibility for projects or higher workload than Risk Adjustment Coding Specialist I Perform additional duties as assigned Qualifications Must possess and maintain AAPC certification, CPC and CRC At least 3 years of experience in risk adjustment coding and/or billing At least 1 year of experience with targeted provider education Reliable transportation/valid driver’s license; able to travel up to 75% of work time Proficient PC skills and experience using Microsoft Word, Excel, and Outlook Excellent presentation, verbal and written communication skills and ability to collaborate Ability to educate and train provider office staff members Proficiency with healthcare coding software and Electronic Health Records (EHR) systems Preferred Qualifications Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage Strong PowerPoint and public speaking experience Ability to work independently and collaborate in a team setting Experience with Monday.com Experience collaborating with, educating, and presenting to provider teams in a face‑to‑face setting Environmental Job Requirements and Working Conditions The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job‑related factors. This role follows a hybrid work structure where the expectation is to work in the office, in the field and at home on a weekly basis. Clinically, the position requires up to 75% travel to provider offices in Houston. 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 legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at View email address on click.appcast.io to request an accommodation. #J-18808-Ljbffr Astrana Health Management