Hybrid Supervisor – Risk Adjustment

at Astrana Health

• Job title: Supervisor – Risk Adjustment
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $80,000 - $90,000 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Houston, United States

About the role

• Risk Adjustment Coding Supervisor overseeing coding operations and compliance at Astrana Health. Mentoring staff and driving data-driven improvements for quality care and CMS guidelines compliance.

Responsibilities

• Supervise, coach, and mentor Risk Adjustment Coding Specialists to ensure high-quality, compliant coding practices.
• Serve as a resource for coders regarding ICD-10-CM, HCCs, CMS Risk Adjustment guidelines, and documentation standards.
• Monitor individual and team productivity, accuracy, and quality metrics; provide ongoing feedback and corrective action as needed.
• Utilize productivity, quality, and audit data to identify performance trends, coding gaps, and training opportunities.
• Translate data insights into actionable feedback, performance improvement plans, and targeted education.
• Assist with onboarding and training of new coding staff.
• Support the Risk Adjustment Manager with day-to-day departmental operations, workflow coordination, prioritization of audits, and issue resolution.
• Assist in developing and maintaining standard operating procedures, workflows, and best practices.
• Analyze Risk Adjustment data (e.g., recapture rates, audit findings, productivity, denial trends) to support departmental strategy and prioritization.
• Collaborate with leadership to design and implement new or enhanced workflows for coders based on data, performance metrics, and operational needs.
• Support reporting and dashboard development to track coding performance, quality outcomes, and Risk Adjustment impact.
• Escalate operational, compliance, or performance issues to leadership as appropriate.
• Review provider documentation and medical records to ensure all Medicare Advantage and Commercial Risk Adjustment requirements are met.
• Perform and/or oversee retrospective and prospective medical record reviews to identify, assess, monitor, and document HCC coding opportunities.
• Conduct coding quality audits to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
• Analyze audit results to identify systemic coding or documentation trends and recommend process improvements.
• Prepare audit analyses and provide feedback on noncompliance or documentation improvement opportunities.
• Interact with physicians and provider office staff regarding coding, billing, and documentation policies and procedures.
• Deliver education and training on Risk Adjustment and documentation improvement, both individually and in group settings.
• Assist with the development of educational materials and presentations, including PowerPoint content.

Requirements

• Minimum of 4–5 years of medical coding experience, including Risk Adjustment and HCC coding.
• Prior lead, senior, or supervisory experience.
• Strong knowledge of Medicare Advantage Risk Adjustment and Hierarchical Condition Categories (HCC).
• Strong data analysis skills with the ability to interpret coding, audit, and performance metrics.
• Ability to identify patterns and trends within Risk Adjustment data to inform decision-making and workflow design.
• Experience using data to drive operational improvements and support Risk Adjustment initiatives.
• Advanced Excel skills preferred (e.g., pivot tables, reporting, data analysis).
• Excellent verbal, written, and presentation skills.
• Demonstrated ability to educate and train coding staff and provider office personnel.
• Expert-level proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.
• Strong organizational, analytical, and problem-solving skills.

Benefits

• Our organization follows a hybrid work structure where the expectation is to work both onsite and at home on a weekly basis. Up to 75% travel is required in designated market(s).
• The total compensation target pay range for this role is $80,000 - $90,000 per year.
• Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer.