Risk adjustment coding auditor jobs

TEKsystems MD

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

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Risk Adjustment Coding Auditor

ClinDCast LLC Albany, NY

Job Summary: 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: 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 Proficiency in Microsoft Office Suite (Excel, Word, Outlook) This is a remote position.

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Risk Adjustment Coding Auditor

Clever Care Health Plan Huntington Beach, CA

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...

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Risk Adjustment Coding Auditor

Vytwo Prosper, TX

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

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Risk Adjustment Coding Auditor

Clever Care Health Plan Huntington Beach, CA

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...

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Hybrid Risk Adjustment Coding Auditor (HCC/RADV)

Clever Care Health Plan Huntington Beach, CA

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

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Risk Adjustment Coding Auditor

Vytwo Technologies Inc. Prosper, TX

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

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Risk Adjustment Coding Auditor

Vytwo Dallas, TX

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

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Risk Adjustment Coding Auditor

TEKsystems St. Louis, MO

*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...

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Senior Risk Adjustment Coding Auditor - Audit Specialist

Vytwo Technologies Inc. Prosper, TX

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

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Risk Adjustment - Risk Adjustment Coding Auditor

CommUnityCare Tulsa, OK

Risk Adjustment AuditorThe 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...

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Risk Adjustment - Risk Adjustment Coding Auditor

CommUnityCare Tulsa, OK

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)...

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Risk Adjustment Coding Auditor

ClinDCast LLC United States

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...

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Risk Adjustment Compliance & Coding Auditor

Kaiser Permanente Pasadena, CA

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

Part Time

Certified Medical Coder

Planned Parenthood of the Rocky Mountains Remote

About Us : Planned Parenthood is committed to creating a dynamic work environment that values diversity, equity, inclusion, respect, integrity, customer focus, and innovation. We are committed to creating a welcoming space for all people on our staff, in our health centers, and in our community. We do this by tending to the team, respecting and honoring all people, jumping in, trying and learning, caring for our business, and returning to our mission. Abortion Care : At PPRM, we all work in abortion care. This role supports abortion care through direct clinical triage, patient education, and follow-up, ensuring timely and empathetic support to those navigating abortion services. Ideal Candidate: Active AAPC Certified Professional Coder (CPC) or equivalent required AAPC Certified Risk Adjustment Coder (CRC) required CPMA preferred Minimum 3 years of outpatient medical billing and coding, ideally in preventive, reproductive, or family‑planning...

Full Time

Risk Adjustment Auditor & Physician Educator - Remote

Valley Medical Center Remote

Risk Adjustment Auditor and Physician Educator Health Information Management | Full-Time | Renton, Washington Help Improve Clinical Documentation and Support Better Patient Care Valley Medical Center is seeking an experienced Risk Adjustment Auditor and Physician Educator to join our Health Information Management team. This role combines clinical documentation expertise, risk adjustment auditing, coding knowledge, data analysis, and physician education to help ensure the accurate and complete capture of patient conditions and the clinical complexity of the care we provide. The ideal candidate brings strong experience in Medicare risk adjustment, medical record auditing, ICD-10-CM coding, and physician education , along with the ability to translate complex coding and documentation requirements into practical guidance for providers. This is an opportunity to play a meaningful role in improving documentation quality, supporting value-based care initiatives, and...

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Full Time

MRA Auditor and Educator (Onsite in West Palm Beach, FL)

LA Medical Associates LLC West Palm Beach, FL

Risk Adjustment Coder, Auditor and Educator Location: West Palm Beach, FL (On-site/Local — Multi-Site Primary Care Medical Group) Job Type: Full-Time Department: Coding & Risk Adjustment / Clinical Quality About the Role Our multi-site primary care medical group is seeking an experienced MRA Coder and Educator to lead risk adjustment coding education and training across our West Palm Beach–area clinics. This role is central to ensuring accurate, complete, and compliant HCC/risk adjustment documentation and coding practices among our primary care providers and clinical staff. The ideal candidate is both a coding subject matter expert and a skilled communicator and presenter — someone who can translate complex risk adjustment concepts into clear, actionable training that resonates with busy physicians and site-level management, while building strong, trust-based relationships across the organization. Key Responsibilities...

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Certified Coder and Auditor

Avita Health System Crestline, OH

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. Certified Coder and Auditor Regular Full-Time 5 - Admin Support Crestline, OH, US 3 days ago Requisition ID: 12050 Join Our Team at Avita Health System – Avita Health System - Crestline Avita Health System is proud to serve the communities of Crawford and Richland counties through three hospitals and numerous clinic locations. Over the past few years, we’ve tripled in size, now employing over 2,300 team members and more than 200 physicians and advanced practitioners. Our mission is to deliver high-quality, compassionate care to the people who depend on us. We’re currently seeking a dedicated Certified Coder & Auditor to join our Patient Financial Services Department at our Crestline location. Position Overview Takes a guiding role in the orientation and ongoing education of professional coding team, physicians,...

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Certified Coder and Auditor

Avita Health System Crestline, OH

Join Our Team at Avita Health System – CrestlineAvita Health System is proud to serve the communities of Crawford and Richland counties through three hospitals and numerous clinic locations. Over the past few years, we've tripled in size, now employing over 2,300 team members and more than 200 physicians and advanced practitioners. Our mission is to deliver high-quality, compassionate care to the people who depend on us.We're currently seeking a dedicated Certified Coder & Auditor to join our Patient Financial Services Department at our Crestline location.Position OverviewTakes a guiding role in the orientation and ongoing education of professional coding team, physicians, and advanced practice providers (APPs) involved in the coding and documentation process. Ensures the accuracy of information in these processes is maintained by conducting audits and analyzing chart documentation and, if accuracy is not at the expected level, reeducates and trains providers and staff. Serves...

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Coder I - Billing & Audit - FT - Days - MSS - Hybrid Eligible

Memorial Healthcare System Hollywood, FL

Health Information Management (HIM) Coding SpecialistLocation: Miramar, FloridaAt 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.SummaryReviews 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.ResponsibilitiesEnhances 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...

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Senior QA Coder/Auditor — Risk Adjustment & HCC

Blue Cross Blue Shield of Arizona Phoenix, AZ

Blue Cross Blue Shield of Arizona seeks a Quality Assurance Coder/Auditor to lead risk mitigation education for primary care providers and staff. You will review records, identify at-risk HCCs, and suggest coding improvements based on Medicare guidelines. The role requires CCS-P/CRC/CPC/COC credentials, 5+ years in coding with HCC, and 2+ years auditing; hybrid role within Arizona, standard 40 hours weekly, with ongoing education duties. #J-18808-Ljbffr

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Inpatient Facility Medical Coder

Cedent Life Talent Myrtle Point, OR

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...

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Inpatient Facility Medical Coder (40h Day)

Veracity Myrtle Point, OR

Inpatient Facility Medical Coder (40h Day)RemoteClackamas, ORCandidates 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 Initiative (NCCI);...

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Coding Auditor, Facility

Veracity Myrtle Point, OR

Coding Auditor, FacilityOnsiteClackamas, ORTo 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 Healthcare organization/institutional coding...

215 risk adjustment coding auditor jobs found