Supervisor - Risk Adjustment

Job Description

Description

We are seeking an experienced and motivated Risk Adjustment Coding Supervisor to oversee and support a team of Risk Adjustment Coders. This role is responsible for supervising daily coding activities, ensuring accuracy and compliance with CMS Risk Adjustment guidelines, and supporting the Manager with day-to-day operations of the Risk Adjustment department.

The ideal candidate will value coaching staff and providers, and be highly data-driven, with the ability to analyze coding, audit, and performance data to identify trends, gaps, and opportunities.

We are seeking candidates who have experience with provider education and who are comfortable traveling around Houston 75% of the time!

Our Values:

Put Patients First

Empower Entrepreneurial Provider and Care Teams

Operate with Integrity & Excellence

Be Innovative

Work As One Team

What You'll Do

Team Leadership & Supervision

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

Operational Support

Support the Risk Adjustment Manager with day-to-day departmental operations, including 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

Coding, Auditing & Compliance

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

Provider & Staff Education

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

Other duties as assigned

Qualifications

Travel

Reliable transportation and valid driver’s license

Ability to travel up to 75% of the time within the designated markets, primarily Houston, with travel to Beaumont and San Antonio as needed.

Certifications

Certified Coding Specialist (CCS or CCS-P) OR Certified Professional Coder (CPC)

Certified Risk Adjustment Coder (CRC) (not required but highly preferred)

Experience

Minimum of 4–5 years of medical coding experience, including Risk Adjustment and HCC coding

Prior lead, senior, or supervisory experience

Skills & Abilities

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

You're great for the role if:

Have deep expertise in Risk Adjustment and HCC coding

Are data-driven and comfortable using metrics to guide decisions and improve outcomes

Enjoy analyzing trends and patterns to enhance Risk Adjustment performance

Have experience building or refining workflows that improve coder efficiency and accuracy

Enjoy leading, mentoring, and developing coding professionals

Thrive in a fast-paced, collaborative environment

Are detail-oriented and committed to coding accuracy and compliance

Are comfortable supporting management with operational and workflow needs

Environmental Job Requirements and Working Conditions

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 home office of this department is located at 19500 HWY 249, Suite 570 Houston, TX 77070.

The total compensation target pay range for this role is $80,000 - $90,000 per year. The salary range represents our national target range for this role. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on 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 based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at to request an accommodation.

Additional Information:

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.

Full-time