Risk Adjustment Coding Auditor(CPC, CRC) - USA

If you are interested in below direct client position, please send your resume.

Title: Risk Adjustment Coding Auditor 

Location: Fully Remote (Must be in USA)

Duration : Contract to Hire

JOB DESCRIPTION

Potential for conversion.

Risk Adjustment Coding Auditor
The Impact you will have

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.

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

Required skills and experiences

• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• 5+ years of HCC coding experience in utilizing inpatient and outpatient coding guidelines
• 5+ years of experience auditing Risk Adjustment records
• 1+ years working in a Production environment
• CRC (Certified Risk Coder) in good standing, in addition to required coding certification or ability to obtain certification within the first 6 months of hire, upon possible conversion
• Intermediate level of knowledge in risk adjustment Medicare, ACA Commercial and Medicaid models
• Demonstrated ability to apply critical thinking skills to coding policy interpretation and implementation.
• Experience providing written and verbal guidance on coding errors and trends
• Intermediate (or higher) MS Office (Word, Excel, Powerpoint & Outlook)
• Excellent organizational ability to manage multiple projects and perform in a deadline driven environment
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred skills and experiences

• Bachelor’s degree
• HEDIS/STARS experience
• Provider education experience
• Prior RADV experience
• CPMA or other coding credentials