Risk Adjustment Coding Auditor

This is a fully remote position, open to applicants in Minnesota.

📋 Description

• Review risk adjustment codes to ensure accuracy, consistency, and adherence to coding guidelines and best practices.

• Conduct both retrospective and prospective medical record examinations.

• Verify diagnosis coding in accordance with provider documentation and CMS-HCC standards.

• Detect gaps in coding and documentation that may affect risk adjustment reporting.

• Maintain compliance with HIPAA, privacy, security, and regulatory standards.

• Offer written and verbal insights on coding inaccuracies, trends, and areas for improvement.

• Assist with audit initiatives, production targets, and special projects.

• Serve as a subject matter expert in risk adjustment coding and audit methodologies.

• Fulfill audit deliverables within set timelines and quality benchmarks.

⛳️ Requirements

• Over 7 years of relevant professional experience.

• More than 5 years of HCC coding experience using inpatient and outpatient coding guidelines.

• A minimum of 5 years of experience in Risk Adjustment auditing.

• At least 1 year of experience in a production-oriented environment.

• CRC (Certified Risk Adjustment Coder) certification in good standing.

• Proficient understanding of Medicare, ACA Commercial, and Medicaid risk adjustment models.

• Experience in communicating coding findings and audit results to stakeholders.

• Intermediate skills in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint).

• Strong analytical, organizational, and critical thinking capabilities.

• High School Diploma or equivalent is required.

• Must be authorized to work in the United States without sponsorship.

🏝️ Benefits

• Medical, dental & vision coverage.

• Critical Illness, Accident, and Hospital insurance.

• 401(k) Retirement Plan with options for both pre-tax and Roth post-tax contributions.

• Life Insurance (Voluntary Life & AD&D for employees and their dependents).

• Short and long-term disability coverage.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

• Paid Time Off/Leave (PTO, Vacation, or Sick Leave).