Coding & Revenue Integrity Specialist

Description

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

What You'll Do

• Conduct prospective and retrospective chart audits to ensure coding accuracy, documentation integrity, and regulatory compliance.
• Accurately assign ICD-10-CM, CPT, HCPCS, and modifier codes based on provider documentation and coding guidelines.
• Validate HCC and Risk Adjustment diagnoses and identify documentation opportunities that support accurate risk capture.
• Identify coding, documentation, and compliance gaps and provide actionable feedback to providers and operational teams.
• Perform routine coding audits, track findings and trends, and support corrective action initiatives.
• Deliver provider and staff education on documentation standards, coding requirements, compliance guidelines, and risk adjustment best practices.
• Support clean claim submission, denial prevention efforts, revenue optimization, and resolution of coding-related billing issues.
• Collaborate with Revenue Cycle, Quality, Clinical Operations, and provider teams to improve workflows and revenue integrity outcomes.
• Assist with audit readiness activities and maintain compliance with CMS, payer, HIPAA, and organizational requirements.
• Contribute to process improvement initiatives that strengthen coding quality, reimbursement accuracy, and overall revenue cycle performance.

Qualifications

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
• At least 3-5 years of experience in medical coding, billing, auditing, revenue cycle management, or related healthcare operations.
• Strong knowledge of ICD-10-CM, CPT, HCPCS, modifier usage, medical terminology, and documentation standards.
• Experience supporting Medicare, Medicare Advantage, Medicaid Managed Care, and Commercial payer programs preferred.
• Knowledge of risk adjustment, HCC coding, provider documentation improvement, and compliance requirements.
• Experience conducting coding audits and providing provider education and feedback.
• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.
• Proficiency with EHR platforms and Microsoft Office Suite; experience with eClinicalWorks preferred.
• Ability to manage multiple priorities while working independently in a remote environment.
• An authentic passion for operational excellence, compliance, and advancing value-based care initiatives.

• Certified Professional Coder (CPC) through AAPC
  • OR
• Certified Coding Specialist (CCS or CCS-P) through AHIMA

• Certified Risk Adjustment Coder (CRC)
• Certified Professional Medical Auditor (CPMA)
• Certified Professional Biller (CPB)
• Certified Medical Reimbursement Specialist (CMRS)

Environmental Job Requirements and Working Conditions

• This is a remote position supporting Astrana Health operations.
• Candidates must reside within the Las Vegas, Nevada market.
• Required onsite attendance for quarterly meetings, provider education sessions, trainings, and other operational activities as needed.
• Must maintain a secure and HIPAA-compliant home office work environment.
• Frequent computer use, auditing activities, and extended periods of reviewing electronic medical records are required.
• The target compensation range for this role is $25.00 - $31.00 per hour. Compensation may vary based on experience, certifications, education, skills, internal equity, and business needs.