Role Description The Medical Coder is responsible for independently reviewing, analysing, and resolving all assigned front-end claims to ensure accurate and timely claim submission. This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies. The Medical Coder works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. This role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment. A Day in the Life - Averages 10 front-end holds per hour - Maintains a minimum of 90% coding accuracy - Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment - Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses - Ensures all diagnosis codes meet local and national medical necessity guidelines - Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services - Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality - Maintains current knowledge of laws, regulations, payer policies, and industry guidance impacting compliant coding practices - Independently reviews and resolves all assigned front-end claim holds - Actively participates in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead - Escalates identified client trends to the assigned Coding Team Lead - Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification - Maintains and completes all CEU requirements - Performs other duties or tasks as assigned Pay Range $24-$28/HR. It's a full time non exempt role. Qualifications - Must hold a current AAPC or AHIMA Certification for a minimum of 3 years - Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines - Familiarity with proper English grammar, usage, and professional documentation standards - Ability to research and analyze data, draw logical conclusions, and resolve coding or documentation issues - Ability to read, interpret, and apply policies, procedures, laws, and regulations - Ability to accurately read and interpret medical documentation, clinical terminology, and documented procedures - Demonstrated ability to exercise independent judgment in coding and claim resolution - Excellent written and verbal communication skills, including the ability to prepare reports, clarify documentation needs, and maintain collaborative working relationships with physicians and staff - Strong commitment to maintaining confidentiality and safeguarding protected health information - Prior experience working in a medical billing environment with strict adherence to HIPAA compliance requirements - Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams) - Minimum of 3+ years of professional coding experience Benefits - Generous Paid Time Off: Recharge and relax with 20 days of fixed time off per year, in addition to company holidays - Best-in-Class Parental Leave: Spend quality time with your growing family - Recognition & Rewards: Get rewarded with monetary incentives and company-wide recognition for your impact and dedication - Comprehensive Insurance Coverage: Stay covered with medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance

• The Medical Coder is responsible for independently reviewing, analyzing, and resolving all assigned front-end claims to ensure accurate and timely claim submission. • This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies. • The Medical Coder works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. • This role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment.

Role Description The Medical Coder is responsible for independently reviewing, analysing, and resolving all assigned front-end claims to ensure accurate and timely claim submission. This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies. The Medical Coder works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. This role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment. A Day in the Life - Averages 10 front-end holds per hour - Maintains a minimum of 90% coding accuracy. - Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment. - Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses. - Ensures all diagnosis codes meet local and national medical necessity guidelines. - Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services. - Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality. - Maintains current knowledge of laws, regulations, payer policies, and industry guidance impacting compliant coding practices. - Independently reviews and resolves all assigned front-end claim holds. - Actively participates in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead. - Escalates identified client trends to the assigned Coding Team Lead. - Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification. - Maintains and completes all CEU requirements. - Performs other duties or tasks as assigned. Qualifications - Must hold a current AAPC or AHIMA Certification for a minimum of 3 years. - Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines. - Familiarity with proper English grammar, usage, and professional documentation standards. - Ability to research and analyze data, draw logical conclusions, and resolve coding or documentation issues. - Ability to read, interpret, and apply policies, procedures, laws, and regulations. - Ability to accurately read and interpret medical documentation, clinical terminology, and documented procedures. - Demonstrated ability to exercise independent judgment in coding and claim resolution. - Excellent written and verbal communication skills, including the ability to prepare reports, clarify documentation needs, and maintain collaborative working relationships with physicians and staff. - Strong commitment to maintaining confidentiality and safeguarding protected health information. - Prior experience working in a medical billing environment with strict adherence to HIPAA compliance requirements. - Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams). - Minimum of 3+ years of professional coding experience. Benefits - Generous Paid Time Off: Recharge and relax with 20 days of fixed time off per year, in addition to company holidays—because we believe work-life balance fuels performance. - Best-in-Class Parental Leave: Spend quality time with your growing family. We offer one of the industry’s most generous parental leave policies to support you during life’s most important moments. - Recognition & Rewards: We celebrate wins—big and small. Get rewarded with monetary incentives and company-wide recognition for your impact and dedication. Your hard work won’t go unnoticed. - Comprehensive Insurance Coverage: Stay covered with medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance. Optional perks include discounted legal aid and pet insurance.

Role Description We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our IPAs across the nation. 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. - Translating findings into actionable insights and delivering education to providers and practice leaders. - Tracking and reporting on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs. Additionally, you will: - Review provider documentation of diagnostic data from medical records to verify compliance with Medicare Advantage, ACO, and Commercial risk adjustment documentation requirements. - 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 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. - 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. - 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. - Provide peer-to-peer guidance through informal discussion and overread assignments. - Assist or lead projects and/or handle a higher work volume than Risk Adjustment Coding Specialist I. - Perform other duties as assigned. Qualifications - Must be open to traveling to provider sites within Connecticut and possibly surrounding areas. - Reliable transportation and valid Driver’s License required. - Certified Professional Coder (CPC) certification from AAPC. - Certified Risk Adjustment Coder (CRC) certification from AAPC. - 3-5+ years of experience in risk adjustment coding and billing experience. - PC skills and experience using Microsoft applications such as 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. - Strong knowledge with PowerPoint, preparing presentations, and public speaking. - Strong experience with Excel - reports, pivot tables, VLOOKUP, etc. Requirements - Strong billing knowledge and/or Certified Professional Biller (CPB) through AAPC highly preferred. - Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage. - Experience with multiple EMR/EHR systems. - Experience with Monday.com and PowerBI. - Ability to work independently and collaborate in a team setting. - Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting. Benefits - The national target pay range for this role is $70,000 - $85,000 per year. - Actual compensation will be determined based on geographic location, experience, and other job-related factors. - This role will be fully remote and likely work in CST hours, with some work across time zones as necessary. - This is a full-time position, M-F 8:30 AM - 5:00 PM. Company Description 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.