Blue Cross and Blue Shield of Minnesota is looking for a Risk Adjustment Coding Auditor. The role ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. Responsibilities Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices. Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements. Performs retrospective and prospective chart reviews to ensure accurate risk adjustment reporting. Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider‑reported diagnosis codes based on medical record documentation. Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories. Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements. Contributes to audit and production efforts to meet business demand and workload priorities. Provides written and verbal guidance on coding errors to others. Meets audit deliverables within established timelines and deadlines. Assists with special projects such as risk mitigation reviews. Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment. Required Skills and Experiences 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered. 5+ years of HCC coding experience in utilizing inpatient and outpatient coding guidelines. 5+ years of experience auditing Risk Adjustment records. 1+ year working in a production environment. CRC (Certified Risk Coder) in good standing, in addition to required coding certification or ability to obtain certification within the first 6 months of hire. Intermediate level of knowledge in risk adjustment Medicare, ACA Commercial and Medicaid models. Demonstrated ability to apply critical thinking skills to coding policy interpretation and implementation. Experience providing written and verbal guidance on coding errors and trends. Intermediate (or higher) MS Office (Word, Excel, Powerpoint & Outlook). Excellent organizational ability to manage multiple projects and perform in a deadline‑driven environment. High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills and Experiences Bachelor’s degree. HEDIS/STARS experience. Provider education experience. Prior RADV experience. CPMA or other coding credentials. Role Designation Teleworker – working full time remote. Hybrid – minimum of 2 days onsite. Onsite – full-time onsite. Compensation and Benefits Hourly pay range: $31.48 - $39.35 - $47.22 (based on position and qualifications). Medical, dental, and vision insurance. Life insurance. 401(k). Paid Time Off (PTO). Volunteer Paid Time Off (VPTO). Additional benefits available; please review our benefits page. Equal Employment Opportunity Statement Blue Cross and Blue Shield of Minnesota is an Equal Opportunity Employer and maintains an affirmative action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on, any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in applying, please contact talent.acquisition@bluecrossmn.com. #J-18808-Ljbffr