240 risk adjustment coding auditor jobs found

Job Overview Role type: Risk Adjustment Coding Auditor. Quantity of resources: 2. Duration: 6 months. JD: This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV's. Required Skills MS Suite CPC certified CRC certified 5+ years of risk adjustment experience Equal Opportunity Statement We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. #J-18808-Ljbffr

Job Description Job Description Role type: Risk Adjustment Coding Auditor Quantity of resources: 2 Duration: 6 months JD: This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV's. Required skillset: MS Suite CPC certified CRC certified 5+ years of risk adjustment experience

TEKsystems is seeking a Risk Adjustment Coding Auditor to ensure accuracy of coded clinical data across risk adjustment programs. This contract position, based out of Eagan, MN but fully remote, requires CRC certification and 3+ years of auditing risk adjustment records. You will review CMS HCC categories, ensure compliance, and guide others on coding errors. The role emphasizes data integrity, regulatory compliance, and collaboration with stakeholders to mitigate financial and regulatory risk #J-18808-Ljbffr

Dahl Consulting seeks a Risk Adjustment Coding Auditor for a remote role in the United States, with eligibility limited to listed states including MN. This contract position spans 4 months with potential conversion to full-time, offering $35–$38 per hour in the health insurance sector. You will evaluate risk adjustment codes for accuracy, review documentation, and ensure compliant reporting across CMS HCC programs while mitigating financial and regulatory risk. #J-18808-Ljbffr

Risk Adjustment Coding Auditor Location: Remote (U.S.) Employment Type: Contract-to-Hire About the Role The Risk Adjustment Coding Auditor is responsible for ensuring the accuracy, completeness, and compliance of diagnosis coding used in risk adjustment programs. This role conducts prospective and retrospective chart audits, validates diagnosis code capture, identifies documentation opportunities, and provides coding guidance to support regulatory compliance and appropriate reimbursement. The auditor serves as a subject matter expert in risk adjustment coding and works closely with internal teams to maintain data integrity and reduce financial and regulatory risk. Key Responsibilities Perform prospective and retrospective medical record reviews and audits. Validate diagnosis code accuracy, completeness, specificity, and appropriateness based on provider documentation. Review medical records to ensure proper capture of CMS-HCC diagnoses and risk adjustment...

*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...

Dahl Consulting seeks a Risk Adjustment Coding Auditor for a remote role in the United States, with eligibility limited to listed states including MN. This contract position spans 4 months with potential conversion to full-time, offering $35–$38 per hour in the health insurance sector. You will evaluate risk adjustment codes for accuracy, review documentation, and ensure compliant reporting across CMS HCC programs while mitigating financial and regulatory risk. #J-18808-Ljbffr

*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...

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...

Risk Adjustment Coding Auditor 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...

TEKsystems is seeking a Risk Adjustment Coding Auditor to ensure the accuracy of coded clinical data and compliant reporting for risk adjustment programs. The role supports improved data integrity and safer reimbursement across Medicare, ACA, and Medicaid models. The candidate will review charts, verify providers’ diagnoses, and apply CMS HCC guidelines while maintaining regulatory compliance and strong data governance in a remote contract setup. #J-18808-Ljbffr

This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who Are We? Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. Why Join Us? We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary The Risk Adjustment Coding Auditor is responsible for conducting...

Vytwo Technologies Inc. seeks a Risk Adjustment Coding Auditor to perform first and second pass auditing for CMS RADV programs. The role supports a small team with two resources over a 6-month duration, ensuring accuracy and compliance in coding and documentation. The candidate should be a certified risk adjustment coder with CPC and CRC credentials and at least five years of risk adjustment experience. #J-18808-Ljbffr

Risk Adjustment Coding Auditor Role type: Risk Adjustment Coding Auditor Quantity of resources: 2 Duration: 6 months This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV's. Required Skillset MS Suite CPC certified CRC certified 5+ years of risk adjustment experience #J-18808-Ljbffr

Clever Care Health Plan is hiring a Risk Adjustment Coding Auditor to conduct retrospective and prospective coding audits, validate diagnoses, and monitor CMS RADV compliance. The role focuses on HCC coding, documentation improvement, and education for providers across a fast-growing Medicare Advantage program. Candidates should have 5+ years in MA risk adjustment or related audits, with strong knowledge of ICD-10-CM guidelines and MEAT criteria. #J-18808-Ljbffr

Job Details Location: Huntington Beach Office, Huntington Beach, CA 92647. Position Type: Full Time. Salary Range: $72,800.00 – $80,000.00. This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Job Summary The Risk Adjustment Coding Auditor is responsible for conducting retrospective and prospective coding audits, diagnosis validation reviews, provider documentation assessments, and compliance monitoring activities to support accurate Medicare Advantage risk adjustment reporting and CMS audit readiness. This role reviews medical record documentation and ICD-10-CM diagnosis coding to ensure compliance with CMS Risk Adjustment program requirements, Official Coding Guidelines, AHA Coding Clinic guidance, and organizational policies. Functions & Responsibilities Conduct retrospective, prospective, and targeted coding audits to assess the accuracy, completeness, and compliance of ICD-10-CM diagnosis coding and HCC capture....

Alignment Health is seeking a qualified MRA Coding Auditor to support QA audits of internal coding teams and vendors. The role ensures accurate data submissions to CMS and supports risk adjustment audits, including RAF, prevalence, and documentation improvement. Candidates should have CCS/CCP/CPC and at least three years in Medicare risk adjustment coding. The position emphasizes data integrity, compliance with HIPAA, and ongoing professional development within a fast-growing team dedicated to #J-18808-Ljbffr

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...

CVS Health is seeking a dedicated coder/auditor to review medical records and abstract ICD codes for CMS risk adjustment. The role ensures codes are accurate, documented, and compliant with state and federal regulations. The position requires CPC/CCS-P credentials, 1+ year of related experience, and proficiency with ICD coding and Microsoft Office. Full-time, on-site, with a strong benefits package. #J-18808-Ljbffr

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 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...

MRA Coding Auditor 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. Job Description 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,...

Empowering the Future of Healthcare The healthcare industry is on the brink of a paradigm shift where patients are increasingly being viewed as empowered consumers, utilizing digital technologies to better understand and manage their own health. As a result, there is a growing demand for a range of patient-centric services, including personalized care that is tailored to each individual's unique needs, health equity that ensures access to care for all, price transparency to make healthcare more affordable, streamlined prior authorizations for medications, the availability of therapeutic alternatives, health literacy to promote informed decision-making, reduced costs, and many other initiatives designed to improve the patient experience. ClinDCast is at the forefront of shaping the future of healthcare by partnering with globally recognized healthcare organizations and offering them innovative solutions and expert guidance. Our suite of services is designed to cater to a broad range...

Empowering the Future of Healthcare The healthcare industry is on the brink of a paradigm shift where patients are increasingly being viewed as empowered consumers, utilizing digital technologies to better understand and manage their own health. As a result, there is a growing demand for a range of patient-centric services, including personalized care that is tailored to each individual's unique needs, health equity that ensures access to care for all, price transparency to make healthcare more affordable, streamlined prior authorizations for medications, the availability of therapeutic alternatives, health literacy to promote informed decision-making, reduced costs, and many other initiatives designed to improve the patient experience. ClinDCast is at the forefront of shaping the future of healthcare by partnering with globally recognized healthcare organizations and offering them innovative solutions and expert guidance. Our suite of services is designed to cater to a broad...