MEDICAL CODING SPECIALIST Fully Remote • Remote N/A Job Type Full-time Description MAKE A DIFFERENCE AT OCHIN OCHIN is a nonprofit leader in health care innovation and a trusted partner to a growing national provider network, delivering the clinical insights and tailored technologies needed to expand patient access, strengthen care teams, and improve the health of rural and medically underserved communities. We are hiring for a number of new positions to meet increasing demand. When you choose to join OCHIN, you have the opportunity to continuously grow your skills and do meaningful work to help fulfill our vision of good health and well-being for everyone. At OCHIN, we value the unique perspectives and experiences of every individual and work hard to maintain a culture rooted in our values. Founded in Oregon in 2000, OCHIN employs a growing virtual workforce of more than 1,200 skilled professionals, working remotely across 49 states. We offer a generous compensation package and are committed to supporting our employees’ entire well-being by fostering a healthy work-life balance and opportunity for professional advancement. We are curious, collaborative learners who strive to live our values every day. OCHIN is excited to support our continued national expansion and the increasing demand for our innovative tools and services by welcoming new talent to our growing team. Position Overview: The Coding Specialist plays a critical role in delivering accurate and high-quality healthcare coding services to OCHIN member clinics and acute care hospital organizations. This position is responsible for identifying potential high-risk coding trends, applying best practices to optimize revenue, and enhancing coding accuracy to support a streamlined and efficient revenue cycle. The Coding Specialist proactively escalates complex or unique coding issues, collaborates with supervisors to resolve challenges, and applies newly acquired knowledge to future scenarios. Additionally, this role contributes to continuous improvement efforts by recommending process enhancements that increase operational efficiency and effectiveness. Essential Functions: - Accurate and Compliant Coding: Deliver efficient and accurate coding services on behalf of member clients, ensuring full compliance with payer requirements, organizational policies, and all applicable coding guidelines. - Clinical Data Abstraction: Extract and interpret relevant clinical data—including diagnoses and procedures—from patient medical records and electronic health systems to support accurate code assignment. - Code Assignment and Validation: Review and analyze patient encounters to assign appropriate diagnosis and procedure codes, ensuring accuracy and completeness for all relevant clinical information. - Reimbursement Optimization: Support member organizations in achieving appropriate reimbursement by reviewing and recommending accurate code assignments that are critical to third-party payer claims. - Provider Communication and Documentation Follow-Up: Conduct research and obtain additional information from providers or clinical staff via Epic In-Basket messaging, as needed and in accordance with established agreements. Messaging, as needed and in accordance with established agreements. - Other duties as assigned. Requirements - Minimum 2 years' experience in Outpatient and Inpatient billing and / or coding revenue cycle experience is required. - Working knowledge of Medicare, Medicaid, MVA, Workers Comp and private insurance billing and reimbursement processes, legal requirements knowledge preferred. - Required certifications Outpatient include: - Medical coding from AAPC (CPC Certificate) or AHIMA (CCS Certificate) and Current certification from ADCA (CDC certificate) - Required certifications for Inpatient include: - Certified Inpatient Coder (CIC) Or AHMIA Inpatient certification - Prior to moving forward to the team interview, all candidates are required to complete a 50–60-minute competency assessment. The assessment gives us insights into how your strengths, preferences, and work style align with the OCHIN's nine core competencies. It’s not about passing or failing—it’s about understanding fit and setting you up for success. Physical Requirements/Work Environment: - Constant interpersonal skills, teamwork, and customer service. Frequent creativity, mentoring, presentations/teaching. Occasional decision making and independent judgment or action. - Reading, speaking, writing, and understanding English. - While performing the duties of the job, the employee is regularly required to sit for long periods of time; stand and walk; use hands to finger, handle or feel; reach with hands and arms. - This position requires a virtual home-office environment, working remotely and will require that employees be on camera for all virtual meetings. - The role routinely uses standard office equipment such as computers and mobile devices. Base Pay Overview OCHIN uses broadened pay bands to support equitable and market-aligned compensation practices. The final offer will be based on a variety of factors, including relevant skills, certifications, education, experience, training, responsibilities, internal equity, and market data. Work Location and Travel Requirements OCHIN is a 100% remote organization with no physical corporate office location. Employees work remotely from home and many of our positions also support our member organizations on-site for new software installations. Nationwide travel is determined based on OCHIN business needs. Please inquire during the interview process about travel requirements for this position. Work from home requirements are: - Ability to work independently and efficiently from a home office environment - High Speed Internet Service - It is a requirement that employees work in a distraction free workplace Salary Description $23.56 -$37.69

Role 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. - Tracking and reporting 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 at least 3 years of risk adjustment experience and reside in an area that operates in the central time zone. Qualifications - Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - Certified Coding Specialist (CCS-P), CCS, or CPC. - At least 3 years of experience in risk adjustment coding and/or billing experience required. - Reliable transportation/Valid Driver’s License/Must be able to travel up to 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. - Proficiency with healthcare coding software and Electronic Health Records (EHR) systems. Requirements - Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC. - Certified Risk Adjustment Coder (CRC) and/or Risk Adjustment coding experience. - 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. Benefits - The national target pay range for this role is $55,000 - $70,000 per year. Actual compensation will be determined based on geographic location, experience, and other job-related factors. - This is a remote position. Candidates must live in an area within the central time zone. 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. 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.

• Reviews complete inpatient medical records, including physician notes, operative reports, consultations, imaging, lab results, and discharge summaries • Assigns and properly sequences accurate ICD-10-CM diagnosis and ICD-10-PCS procedure codes in accordance with Official Coding Guidelines, UHDDS definitions, Coding Clinic guidance, and CMS to a full range of inpatient services including cases with a high complexity level • Assigns correct and optimal DRGs (MS-DRG/APR-DRG) • Ensures accurate capture of Major Comorbid Conditions (MCC)/Comorbid Conditions (CC), Present on Admission (POA) indicators, Hospital-Acquired Conditions (HACs), Patient Safety Indicators (PSIs), Severity of Illness (SOI), and Risk of Mortality (ROM) • Issues compliant physician queries when documentation is incomplete, ambiguous, or inconsistent • Identifies documentation gaps and escalates when clarification is needed • Resolves coding edits, queries, and discrepancies in a timely and compliant manner • Participates in internal and external audits; assists in implementing corrective action plans • Collaborates with Clinical Documentation Improvement (CDI) to ensure complete documentation and optimal DRG assignment • Supports coding leadership by identifying documentation improvement opportunities and workflow challenges • Meets or exceeds departmental accuracy and productivity standards • Codes inpatient encounters efficiently to support timely billing and reduce DNFB • Assists with reviewing accounts held for coding-related issues • Maintains required coding credentials (CCS, RHIT, RHIA) • Stays current with all annual ICD-10-CM/PCS updates, DRG changes, and regulatory updates • Participates in continuing education, team meetings, and training sessions • Adapts to changing department demands required to maintain a high level of performance • Performs other duties as assigned

• Responsible for entering/auditing/coding patient services to ensure encounters transfer properly for submission to insurance payers. • Analyze coding related claim issues, process gaps and denials to trend feedback for providers by location and/or specialty. • Review provider documentation (including hospital procedures) and translate services into correct codes. • Append payer specific modifiers and claim criteria when applicable. • Review incomplete encounters and code based on available documentation in EHR systems. • Know and understand several different coding systems, including ICD-10-CM, ICD-10-PCS, CPT, Level 1 HCPCS and Level 2 HCPCS. • Use computers / billing software to create and bill encounters that generate clean claims. • Attend internal meetings relevant to EHR workflows and share best coding practices. • Assist Operations when coding guidance is requested for existing or new services. • Understand payer reimbursement and PPS visit qualification for Medicare and Medicaid. • Trend areas of focus where provider training or re-training is needed. • Monitor, trend and resolve tasks related to coding edits, rejections, and denials. • Communicate with providers, patients, and insurance payers. • Review patient accounts and correct any missing or inaccurate information. • Investigate and appeal claims that were denied incorrectly. • Complete coding projects such as quarterly or ad hoc provider chart audits. • Adapt to updates and changes in billing software. • Perform all other duties and tasks as assigned.