Certified Medicare Compliance Auditor

Job Summary

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

Key responsibilities

• Conducts audits and reviews of coding practices to ensure compliance and accuracy
• Maintains tracking tools for risk adjustment compliance and monitors corrective action plans
• Collaborates with Risk Adjustment Management on data validation and audit processes

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 related field, or 4 years of additional experience in lieu of education
• Certified Coder required - CPC, CCS, or CCS-P
• Experience with strategic planning in risk mitigation
• Proficient in MS Office Suite; experience with Epic, Allscripts, or EZCap is a plus