Certified Risk Adjustment Auditor

Job Summary

Supporting auditing and compliance activities related to risk adjustment data submitted to CMS, the full-time remote Certified Risk Adjustment Auditor will conduct provider and coder-level audits, review medical record documentation, and ensure coding accuracy and regulatory compliance.

Key responsibilities

• Monitor coding prevalence reporting and internal reporting trends to support compliance and audit readiness
• Review IPA policies and procedures to ensure compliance with programs
• Collaborate with Risk Adjustment Management on data validation and RADV coding audit activities

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