About this role
About the Role
Astrana Health is seeking a highly skilled Coding & Revenue Integrity Specialist to support accurate, compliant, and optimized revenue cycle performance across Medicare, Medicare Advantage, Medicaid Managed Care, and Commercial payer lines. This role is responsible for provider documentation audits, risk adjustment validation (HCC), coding compliance, provider education, and revenue integrity initiatives that drive organizational performance and reimbursement accuracy. This is a primarily remote position based in Las Vegas, Nevada. Candidates must reside locally and be available to attend onsite meetings, provider education sessions, trainings, and operational activities on a quarterly basis or as needed.
- Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team 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.