182 medical coding auditor risk adjustment jobs found

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This is a remote position. The MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) audits to identify areas of...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This is a remote position. The MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) audits to identify areas of...

JOB DESCRIPTION To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional coding...

Quality Assurance Coder/Auditor The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. On a regular basis, Coder/Auditor will educate primary care providers and their staff on their historical diagnoses/coding error trends, accurate completion of medical record documentation, and at-risk code identification and risk mitigation. This includes the review, analysis, and recommended coding based on medical and clinical diagnoses, procedures, injuries, or illnesses contained in medical records and supporting documentation. The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at-risk single occurrence of HCCs and OIG targets. Deletions will be submitted for unsupported/invalid diagnoses. This analysis combined with QA findings and EDPS claims errors will drive the content and audience for provider education. The Quality Assurance Coder/Auditor will perform medical record reviews...

Risk Adjustment Coding Auditor (Remote) *Location:* 100% Remote (Approved U.S. States Only) *Employment Type:* Contract (5 Months) *Schedule:* First Shift Overview We are seeking experienced Risk Adjustment Coding Auditors to support a growing healthcare organization during a high-volume operational period. This role is ideal for professionals with deep expertise in HCC coding, risk adjustment auditing, and regulatory compliance who thrive in a production-driven environment. This position offers the opportunity to work remotely while contributing to the accuracy, integrity, and compliance of risk adjustment programs that support quality healthcare outcomes and reimbursement processes. Key Responsibilities * Audit risk adjustment codes for accuracy, consistency, and compliance with coding guidelines and best practices * Perform retrospective and prospective medical record reviews * Validate diagnosis coding based on provider documentation and CMS-HCC requirements * Identify...

Location: Eagan, Minnesota, United StatesSalary: $32.00 - $37.00/hrCompany: TEKsystemsPosted: 2026-08-09*Description* The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise. Your 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...

Risk Adjustment Coding AuditorOverviewWe are seeking a detail-oriented Risk Adjustment Coding Auditor to support the accuracy, integrity, and compliance of clinical coding data across risk adjustment programs. In this role, you will conduct audits, review medical record documentation, identify coding opportunities, and provide guidance on coding accuracy to help support compliant reporting and appropriate reimbursement.The ideal candidate will bring extensive HCC coding and risk adjustment auditing experience, strong analytical skills, and a thorough understanding of Medicare, Medicaid, and ACA risk adjustment models.Key ResponsibilitiesPerform retrospective and prospective chart reviews to evaluate risk adjustment diagnosis coding accuracy.Audit medical records to verify the completeness, specificity, and appropriateness of reported diagnoses.Review clinical documentation to ensure accurate HCC capture and risk adjustment reporting.Evaluate coding practices for compliance with CMS...

Medical Coder II Status: Full Time | Non-Exempt Reports to: Health Information and Technology Manager A. Purpose and Scope of Position Responsible for reviewing and interpreting medical records, documents, and other patient data to assign appropriate codes for healthcare procedures, diagnoses, and services provided. These codes are used for insurance reimbursement, statistical purposes, and maintaining accurate patient records. Medical coders work closely with healthcare providers, insurance companies, and billing departments. B. Job Requirements 1. Required Qualifications • Education: High school diploma or equivalent. • Certification: Certification from a recognized body such as the American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or equivalent (e.g., CPC, CCS, or CCA). • Experience: 3+ years of relevant coding experience 2. Preferred Qualifications • Associate's degree in health-related...

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Medical Coder II Red Lodge, MT, US 6 days ago Requisition ID: 1064 Salary Range: $20.83 To $28.63 Hourly Medical Coder II Status: Part Time (20 hours/week) | Non-Exempt Reports to: Health Information and Technology Manager Purpose and Scope of Position Responsible for reviewing and interpreting medical records, documents, and other patient data to assign appropriate codes for healthcare procedures, diagnoses, and services provided. These codes are used for insurance reimbursement, statistical purposes, and maintaining accurate patient records. Medical coders work closely with healthcare providers, insurance companies, and billing departments. Job Requirements Required Qualifications Education: High school diploma or equivalent. Certification: Certification from a recognized body such as the American Academy of...

CVS Health is seeking an experienced Medical Records Auditor/Coder to review provider and vendor records, identify ICD codes, and submit them to CMS for risk adjustment. You will ensure accuracy and compliance with state and federal regulations and internal policies. The role requires at least 1 year of related experience, CPC or CCS-P credentials, proficiency with MS Office, and ICD coding experience. This is a full-time position with comprehensive benefits and opportunities to impact patient #J-18808-Ljbffr

Risk Adjustment Coding Auditor The Impact you will have The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise. Your 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...

Supporting quality assessment audits, the full-time Certified Medicare Coding Auditor will work remotely to ensure accurate data submission to CMS, assist in risk adjustment data audits, and analyze audit results for process improvement. Key responsibilities Conducts regular quality assurance audits of the internal Coding Analyst Team to validate coding accuracy and quality Tracks and reports progress of audits on coding vendors to ensure data accuracy for CMS submissions Collaborates with Risk Adjustment Management on data validation and coding audits to ensure completeness and accuracy of submissions Required qualifications Minimum three years of Medicare Risk Adjustment coding experience in a medical group or health plan setting High School Diploma or GED; completion of a Medical Coding training program Certified Coder (CCS, CCS-P, CPC, CRC, RHIT, or RHIA) required Proficient in MS Office Suite and previous use of electronic health record systems such as Epic or...

Supporting quality assessment audits, the full-time Certified Medicare Coding Auditor will work remotely to ensure accurate data submission to CMS, assist in risk adjustment data audits, and analyze audit results for process improvement. Key responsibilities Conducts regular quality assurance audits of the internal Coding Analyst Team to validate coding accuracy and quality Tracks and reports progress of audits on coding vendors to ensure data accuracy for CMS submissions Collaborates with Risk Adjustment Management on data validation and coding audits to ensure completeness and accuracy of submissions Required qualifications Minimum three years of Medicare Risk Adjustment coding experience in a medical group or health plan setting High School Diploma or GED; completion of a Medical Coding training program Certified Coder (CCS, CCS-P, CPC, CRC, RHIT, or RHIA) required Proficient in MS Office Suite and previous use of electronic health record systems such as Epic or...

Inpatient Facility Medical Coder (40h Day) Remote Clackamas, OR Candidates must reside either in Washington or Oregon to be considered for this position. To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding...

Company Description Job Description To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional...

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities: Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts pertinent data points for billing and quality reviews. Communicates with various departments as needed to ensure accuracy of patient data. Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing). May assign and sequence basic CPT (Current...

Coding Auditor This position is responsible for providing Quality Assurance and coding audit services for risk adjustment purposes, supporting ACA Commercial, Medicare and Medicaid programs. Your Responsibilities Experienced coder who has participated in Regulatory Audits (RADV and HRADV) Reviews patient records in accordance with current compliance policies to analyze provider documentation to ensure that it meets standards and supports the diagnosis and procedure codes selected, including supporting medical necessity severity of illness and risk of mortality Conduct audits on abstracted files to ensure accuracy and completeness of coding by identifying accurate coding opportunities and rechecking all diagnoses and procedures using ICD-CM (ICD-9 and ICD-10) and CPT-4 codes to ensure adherence to all official coding guidelines, federal and state regulations, health system and departmental policies and productivity standards. Demonstrates an understanding of...

*Job Description* The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise. *Your 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...

Profee Coding Auditor (Full-time, Monday-Friday, Days) Washington Regional Med. Ctr. - Fayetteville, AR 72703 Overview Position Type: Full Time Job Shift: Days Education Level: Certification in related field Category: Admissions & Billing Services Description Position Summary The role of the Profee Coding Auditor reports to the Profee Audit Manager. This position is responsible for chart reviews of medical records for clinic, outpatient, and inpatient provider claims. The position is responsible for management, implementation, and delivery of assigned audit phases, including planning, fieldwork, and reporting. Essential Position Responsibilities Conduct focused chart reviews, audits, risk adjustment and compliance reviews on providers and clinics, as directed by management, tracking results and identifying trends and deficiencies for follow up training for providers and coders, as necessary. Report concise and detailed recommendations to improve...

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 and report...

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)...

TruHealth is seeking a Coding and Medical Records Auditor to perform pre- and post-payment coding audits and ensure accurate coding for Medicare Risk Adjustment initiatives. You will review claims, medical records, and related documents to verify diagnosis codes and support proper reimbursement. The role requires strong knowledge of ICD-10, CPT4, HCPCS, and CMS guidelines, with several years in health insurance or managed care auditing preferred. #J-18808-Ljbffr

Location Miramar, Florida Summary Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments. For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding. Submits daily productivity report to HIM manager by defined deadline....