216 risk adjustment coding auditor jobs found

We are an independent, Florida-focused organization with a long-standing commitment to delivering high-quality care to seniors and the communities we serve. Our work centers on improving health outcomes, enhancing the patient experience, and supporting value-based care models. As part of WellMed Optum Florida, team members collaborate across clinical and operational functions to support older adults with compassionate, coordinated care. We foster a culture of integrity, continuous improvement, and respect, offering opportunities for professional growth while making a meaningful impact. Our focus on seniors’ health drives innovation in care delivery, risk adjustment, and provider support across the Greater Tampa Bay Area and beyond. LOCATION The Risk Adjustment Coding Auditor & Provider Educator is a full-time hybrid role based in the Greater Tampa Bay Area, with a mix of onsite visits and some work-from-home flexibility. ABOUT THE ROLE The Coding Auditor / Educator is...

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

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

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....

COMPANY OVERVIEW Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health Description COMPANY OVERVIEW Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more...

Zing Health is seeking a Senior Risk Adjustment Coding Auditor to ensure accurate, compliant coding across Medicare Advantage programs. You will lead audits, validate records, and support RADV activities, driving quality and regulatory compliance. The role requires strong analytical skills and proficiency in Excel and coding platforms. Join a mission-driven team focused on member-centered care, data integrity, and continuous improvement within a fast-paced, innovative environment in Illinois. #J-18808-Ljbffr

Risk Adjustment Coding Auditor 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. 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...

Job Description Title : Risk Adjustment Coding Auditor Location : Remote (To be eligible for this position, candidate must currently reside in one of the following states: AL, AZ, AR, CO, FL, GA, IL, IN, IA, KS, KY, MD, MI, MN, MO, MT, NV, NH, NC, ND, OK, SC, SD, TN, TX, UT, VT, VA, WI.) Job Type : Contract Duration: 4 months, potential for conversion to full-time employee Compensation : $35 - $38/hr Industry: Health Insurance --- About the Role We are partnering with a leading health insurance organization in Minnesota to hire a Risk Adjustment Coding Auditor. Our client is a well-established health plan serving members across commercial, Medicare, and Medicaid lines of business, with a strong commitment to data integrity, regulatory compliance, and accurate reimbursement. In this role, you will ensure the accuracy and completeness of coded clinical data that supports compliant reporting and appropriate reimbursement across risk adjustment programs. You...

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

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 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. 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...

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)...

Sanford Health, the largest rural health system in the United States, seeks a Coding Audit Specialist to ensure the accuracy of CMS/DHS risk adjustment data. You will audit medical records for correct coding (CPT, ICD-9/10, HCPCS) and develop monitoring programs across Medicare Advantage, ACA/Exchange, and BadgerCare Plus. Requirements include a high school diploma, 3 years in health insurance or auditing, and CPC/CRCoder within one year. #J-18808-Ljbffr

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...

Datavant is seeking an HCC Auditor to review medical records coded in ICD-10, ensuring accurate reflection of patient conditions for risk adjustment and reimbursement. The role emphasizes translating clinical documentation into precise codes while maintaining high quality in a fast-paced environment. You will audit coded charts, switch between client guidelines, and participate in weekly project reviews. Strong coding and auditing experience, plus AHIMA or AAPC credentials, are required for #J-18808-Ljbffr

Description COMPANY OVERVIEW Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com. SUMMARY DESCRIPTION The Senior Risk Adjustment Coding Auditor is a highly experienced coding professional responsible for ensuring compliant, accurate, and high-quality risk adjustment coding across Medicare Advantage programs. This role is critical to...

Zing Health seeks a Senior Risk Adjustment Coding Auditor to ensure accurate, compliant risk adjustment coding across Medicare Advantage programs. You will play a key role in RADV audits, vendor quality oversight, and regulatory compliance while driving continuous improvement. The ideal candidate has deep Medicare Advantage expertise, strong project management skills, and a passion for coding excellence within a fast-paced, evolving environment. #J-18808-Ljbffr

Kaiser Permanente is seeking a Compliance Specialist focused on coding functions within all settings of care to ensure alignment with national coding policies and procedures. You will assist with audit readiness, develop compliant documentation, and support regional leadership with findings and corrective actions. You will partner with operational, clinical, and compliance teams to sustain regulatory adherence, drive quality improvements, and maintain the KP code of conduct across all lines of #J-18808-Ljbffr

Certified Medical Auditor Position Summary The Certified Medical Auditor is responsible for conducting comprehensive medical record, coding, billing, and compliance audits to ensure accuracy, completeness, regulatory compliance, and adherence to organizational policies and industry standards. This position reviews clinical documentation and coded data to identify discrepancies, overpayments, underpayments, compliance risks, and opportunities for process improvement. The Certified Medical Auditor works collaboratively with coding, clinical, billing, compliance, and leadership teams to educate staff, improve documentation and coding accuracy, and support ongoing audit and compliance initiatives. Essential Duties and Responsibilities Conduct prospective, concurrent, and retrospective medical record and coding audits. Review medical documentation to validate the accuracy and completeness of ICD-10-CM, CPT, HCPCS, and other applicable coding. Evaluate medical...

Job Title:Quality Assurance Auditor/Coder Location: Phoenix, AZ or Remote Duration: 06 Month+ Conract Pay Range: $45/Hour on w2 Summary We are seeking an experienced Quality Assurance Auditor with coding background. strong background in HCC coding, risk adjustment, and medical record auditing . The ideal candidate will have experience reviewing medical records, conducting QA audits, identifying coding deficiencies, and supporting provider education and risk mitigation initiatives. Required: 5+ years of professional coding experience, 3+ years of HCC/risk adjustment experience, 2+ years of auditing/QA experience, and an active CCS-P, CRC, CPC, or COC certification . Experience with Medicare Advantage, RADV, HEDIS, CMS Star Ratings, and provider education is strongly preferred.

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 Procedural...