236 risk adjustment coding auditor jobs found

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

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...

CHRISTUS Health is seeking a Senior HCC Coding Auditor to perform audits, abstractions, and quality reviews aligned with ICD-10-CM and CMS HCC guidelines. This onsite role offers a remote option within a hybrid structure, supporting Commercial and Medicare Advantage risk adjustment programs. The ideal candidate will have 3+ years of hospital coding/audit experience, AHIMA or AAPC certification, and strong communication skills to educate providers on documentation and coding best practices. #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...

Cano Health is seeking an ACO Coding Auditor to review medical records and ensure Medicare Risk Adjustment codes are captured accurately for CMS and Commercial ACOs. You will act as a consultant to practices, driving quality improvements and compliance across coding procedures. The role requires on-site and remote audits, with travel to clinics as needed. The ideal candidate has CPC/CRC/CCS-P/CCS-H/RHIT certification and 3+ years in Medicare Risk Adjustment, plus strong ICD-10/CPT expertise. #J-18808-Ljbffr

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...

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

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

Datavant is seeking an HCC Auditor to review medical records coded in standardized systems, translate clinical documentation into precise codes, and ensure accurate risk adjustment for reimbursement. You will verify coding accuracy and support data integrity in a remote, high-performing team. The role requires 2+ years in HCC coding and auditing, deep ICD-10 knowledge, and AHIMA or AAPC credentials. Flexible work arrangements and strong quality expectations are offered. #J-18808-Ljbffr

Galen Medical Group is seeking an EMR Coding Auditor II to improve documentation quality and ensure HCC coding accuracy. You will review charts, validate chronic conditions, and coordinate with physicians to maintain up-to-date problem lists in the EMR. You will train new staff and support the team under the Population Health Manager. The role requires expertise in ICD-10/CPT, strong communication skills, and a commitment to quality and compliance. #J-18808-Ljbffr

Job Opportunity At Memorial HermannAt Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Description Responsible for providing accurate, reliable and effective education to physicians and extenders regarding outpatient procedural and diagnosis coding. This position performs individual and group documentation reviews, identifies opportunities for improvement, assists with implementation of physician lead CME documentation and coding courses...