Astrana Health · 3 weeks ago
Risk Adjustment QA Specialist
California, CA
Full-time
Hybrid
Mid, Senior Level
$80K/yr - $90K/yr
5+ years expAstrana Health is seeking an experienced Risk Adjustment QA Specialist to join their team. In this role, you will ensure accurate and compliant documentation through chart audits, provider education, and ongoing monitoring, while delivering actionable feedback to HCC coding auditors and providers to improve documentation practices and meet regulatory standards.
Health CareMedical
Responsibilities
Abstract pertinent information from assigned medical records using ICD-9-CM, ICD-10-CM, CPT and/or HCPCS codes
Provide detailed comments/feedback on physician performance based on encounter audits
Document detailed chart audit findings including all documentation errors; medical record errors; diagnosis errors as well as missed HCC opportunities
Identify documentation training and HCC coding review training opportunities
Encounter audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding, documentation, and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements
Monitor corrective actions for audit review findings
Serves as a local resource in meeting internal and external regulatory requirements (e.g., Centers for Medicare & Medicaid Service (CMS), National Committee for Quality Assurance (NCQA))
Actively participate with local CMS (Center for Medicare/Medical Services) team to ensure local objectives are met and regional CMS compliance activities are supported
Works with medical center leadership to provide confidential audits and feedback on an "as needed" basis
Assist in the identification of operational processes that hinder encounter data capture
Prepare and/or perform auditing analysis and/or special projects as assigned
Provide feedback on noncompliance issues detected through auditing
Provide audit support to the HCC Risk Adjustment program specifically the yearly Wellness Visit Program
Submit bi-weekly and monthly audit finding reports
Qualification
Required
High School Diploma or equivalent
5+ years of experience in a healthcare setting related to HCC Risk Adjustment and chart auditing
Current AAPC or AHIMA certification (CCS, CCS-P, CPC, CPC-H, CPC-P, RHIT, or RHIA)
Strong understanding of CMS Risk Adjustment guidelines, ICD coding, and compliance requirements
Excellent written and verbal communication skills with the ability to educate providers
Strong analytical and problem-solving skills
Ability to work independently and manage multiple priorities in a fast-paced environment
Proficiency with Microsoft Word, Excel, and Outlook
Preferred
Bachelor's degree
Company
Astrana Health
Leading physician-centric, technology-powered, risk-bearing healthcare mgmt. company delivering high quality care in a cost-effective manner
1001-5000 employees
H1B Sponsorship
Astrana Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
Funding
Current Stage
Public CompanyTotal Funding
$334.36MKey Investors
Network Medical ManagementFresenius Medical Care
2019-09-26Post Ipo Equity· $300M
2017-12-20Post Ipo Equity· $5.2M
2017-12-08IPO
Leadership Team
Brandon Sim
Chief Executive Officer & President
Sherry McBride
Chief Operating Officer, MSO
Recent News
2025-12-31
2025-11-11
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