Certified Medicare Compliance Auditor

Job Summary

To ensure accurate risk adjustment data submission to CMS, the full-time Remote Medicare Risk Adjustment Compliance Auditor will conduct provider and coder level reviews, develop tracking tools, and monitor compliance with federal and state regulations.

Key responsibilities

• Conduct audits and reviews of coding practices to identify outliers and ensure compliance with CMS regulations
• Develop and maintain tracking tools for risk adjustment compliance and monitor corrective action plans
• Collaborate with Risk Adjustment Management to validate data accuracy and support coding audits

Required qualifications

• Minimum 3 years of professional coding experience in a medical group or health plan setting
• Bachelor's degree in business administration, health care management, or a related field, or 4 years of additional experience in lieu of education
• Certified Coder (CPC, CCS, or CCS-P) required
• Experience with strategic planning in risk mitigation
• Proficient in MS Office Suite; experience with Epic, Allscripts, or EZCap is a plus