CommUnityCare

JOB SUMMARY: The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity. KEY RESPONSIBILITIES: Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements. Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines. Identify unsupported diagnoses, over coding, under-coding, and documentation gaps. Provide detailed audit findings and recommendations to coding teams, providers, and leadership. Monitor compliance with CMS Risk Adjustment Data Validation (RADV) standards. Track...

Job ID: 6283Req ID: 1133Location: Tulsa, OK, USAPosted: 2026-09-26Job Family: CommercialPay Type: SalaryJOB SUMMARY:The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity.KEY RESPONSIBILITIES:• Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements.• Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines.• Identify unsupported diagnoses, over coding, under-coding, and documentation gaps.• Provide detailed audit findings and recommendations to coding teams, providers,...

JOB SUMMARY: Responsible for supervising and coordinating daily workflow and leadership of staff. Activities include developing operating procedures and managing personnel and resources. KEY RESPONSIBILITIES: Serves as a resource to the department staff by providing technical direction and resolving workflow problems or improvement opportunities within the department. Assesses individual workload and staffing patterns. Selects, assigns, and evaluates personnel, and recommends or initiates associated personnel actions. Takes caseload as needed to assist with staffing needs. Ensure authorization timeframes and regulatory requirements are met. Interviews, hires, trains, and reviews all eligibility personnel in addition to problem-solving and disciplinary actions. Participates in analysis of current policies and procedures and in the development of new or updated standard operating procedures and workflows. Attends departmental, interdepartmental, and facility meetings as needed....

Risk Adjustment Auditor The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity. Key responsibilities include performing bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements. Ensuring documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines. Identifying unsupported diagnoses, over coding, under-coding, and documentation gaps. Providing detailed audit findings and recommendations to coding teams, providers, and leadership. Monitoring compliance with CMS Risk Adjustment Data...

Job TitleResponsible for supervising and coordinating daily workflow and leadership of staff. Activities include developing operating procedures and managing personnel and resources.Key ResponsibilitiesServes as a resource to the department staff by providing technical direction and resolving workflow problems or improvement opportunities within the department.Assesses individual workload and staffing patterns. Selects, assigns, and evaluates personnel, and recommends or initiates associated personnel actions. Takes caseload as needed to assist with staffing needs. Ensure authorization timeframes and regulatory requirements are met.Interviews, hires, trains, and reviews all eligibility personnel in addition to problem-solving and disciplinary actions. Participates in analysis of current policies and procedures and in the development of new or updated standard operating procedures and workflows.Attends departmental, interdepartmental, and facility meetings as needed.Performs other...

OverviewThis position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff.This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD-10 codes on an annual basis.ResponsibilitiesEssential Duties :Conduct prospective and retrospective chart reviews (i.e.baseline, routine periodic, monitoring, and focused) comparing medical and / or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer / title / grant coding requirements.Identify coding discrepancies and formulate suggestions for improvement.Communicate audit results / findings to providers and / or ancillary staff and share improvement ideas.Work with the Office of the CMO and provider leadership to identify and assist providers with coding.Report findings and recommendations to Compliance...