248 risk adjustment coding auditor jobs found

Risk Adjustment Coding Auditor II Galen Medical Group offers several medical specialties throughout the Chattanooga region. We provide quality care and patient-friendly services to adults and children of all ages. Our mission is to elevate the health of our community through multiple medical specialties providing excellent care delivered with wisdom, compassion, integrity, and a commitment to technology, education, and scientific inquiry. Galen is CHATTANOOGA'S Doctor! Summary/Objective: The Risk Adjustment Coding Auditor II is responsible for reviewing and analyzing patient medical records to ensure accurate coding and documentation of chronic conditions based on ICD-10-CM guidelines and CMS standards. This role supports accurate health status assessment to drive appropriate reimbursement and quality care. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical documentation to support...

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...

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

Risk Adjustment Coding Auditor II Galen Medical Group offers several medical specialties throughout the Chattanooga region. We provide quality care and patient-friendly services to adults and children of all ages. Our mission is to elevate the health of our community through multiple medical specialties providing excellent care delivered with wisdom, compassion, integrity, and a commitment to technology, education, and scientific inquiry. Galen is CHATTANOOGA'S Doctor! Summary/Objective: The Risk Adjustment Coding Auditor II is responsible for reviewing and analyzing patient medical records to ensure accurate coding and documentation of chronic conditions based on ICD-10-CM guidelines and CMS standards. This role supports accurate health status assessment to drive appropriate reimbursement and quality care. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical...

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...

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

Risk Adjustment Coding AuditorHuntington Beach Office - Huntington Beach, CA 92647OverviewSalary Range $72,800.00 - $80,000.00 Salary Position Type Full TimeDescriptionAre 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.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 SummaryThe Risk Adjustment Coding...

Location: Dallas, Texas, United StatesSalary: $32.00 - $37.00/hrCompany: TEKsystemsPosted: DescriptionRisk Adjustment Coding AuditorThe 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 ResponsibilitiesEvaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practicesProtects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirementsPerforms Retrospective and Prospective chart reviews to ensure accurate risk adjustment...

Risk Adjustment Coding Auditor We are seeking a Risk Adjustment Coding Auditor with 8+ years of experience to support first- and second-pass audits for CMS RADV (Risk Adjustment Data Validation) projects. The ideal candidate must be CPC and CRC certified with strong risk adjustment coding expertise and proficiency in Microsoft Office Suite. Required skills include 8+ years of Risk Adjustment coding and auditing experience, experience supporting CMS RADV first- and second-pass audits, active CPC (Certified Professional Coder) certification, active CRC (Certified Risk Adjustment Coder) certification, and proficiency in Microsoft Office Suite (Excel, Word, Outlook). This is a remote position. Compensation: $30.00 - $35.00 per hour 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...

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 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: 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...

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

Sanford Health is seeking a Coding Audit Specialist to ensure accurate risk adjustment coding across Medicare Advantage, ACA/Exchange and BadgerCare Plus populations. You will audit medical records, apply CPT/ICD-10 guidelines, and present concise audit outcomes to leadership. Ideal candidates have CPC certification within a year, 3 years in health insurance or auditing, and strong knowledge of CMS guidelines, documentation standards, and data analysis. #J-18808-Ljbffr

Galen Medical Group in Chattanooga is seeking a Risk Adjustment Coding Auditor II to review patient records and ensure accurate ICD-10-CM coding in accordance with CMS standards. You will collaborate with physicians and coding staff to improve documentation and reimbursement. The role emphasizes documentation improvement, compliance with HIPAA and CMS regulations, and data accuracy. Candidates should have CRC and CPC certifications and 3–5 years of coding experience, with CMS-HCC modeling #J-18808-Ljbffr

Prominence Health is a value-based care organization focused on bridging gaps between systems and providers. We seek a Risk Adjustment Coding Supervisor to oversee coding accuracy, policy development, and staff training across CMS HCC programs. The role involves supporting production coding, managing workloads, and contributing to RADV audits and process improvements. Strong attention to detail and certified coding expertise are essential. #J-18808-Ljbffr

Location: Pasadena, California, United StatesCompany: Kaiser PermanentePosted: 2026-09-21Kaiser 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

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

Coding Auditor SeniorCandidates must reside either in Washington or Oregon to be considered for this position.Essential Responsibilities:Proficient in medical record review and translating clinical information into coded data. Identify and assign appropriate codes for diagnoses, procedures and other services rendered, while also validating any Computer Assisted Coded (CAC) assignments for dual coding. Utilizing the Code Base Charge Trigger system (CBCT) and OPTUM 360 EncoderPRO software system for professional surgical services, analyzing and maintaining systems accuracy, validity and meaningfulness for both professional and facility services. Utilizes electronic patient data system and clinical information system (EpicCare) to access patient encounter information. Abstracts and enters clinical data elements as defined by the needs of the organization. Identifies and assigns principal diagnosis and procedure codes, sequencing them as needed for proper Ambulatory Payment...

Professional Fee Coding AuditorAt NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre-billing coding edits, and reviewing post-billing coding-related denials.This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD-10-CM, and payer-specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization.PRIMARY JOB DUTIESAudit ResponsibilitiesPerforms routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee.Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD-10-CM, and payer...

Job Description At NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre‑billing coding edits, and reviewing post‑billing coding‑related denials. This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD‑10‑CM, and payer‑specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization. Primary Job Duties Audit Responsibilities Performs routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee. Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD‑10‑CM, and payer policies....

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...