Certified Risk Adjustment Auditor

Job Summary

Providing audit support for Molina's enterprise risk adjustment activities, the full-time Certified Risk Adjustment Auditor will manage daily operations of risk adjustment data validation and audits, ensuring compliance with CMS regulations while working remotely.

Key responsibilities

• Facilitates daily operations of risk adjustment data validation and audit-related activities, including progress tracking and adherence to timelines
• Represents as a risk adjustment audit liaison with functional departments, health plans, and external vendors
• Evaluates audit results to identify barriers and implement corrective action plans as necessary

Required qualifications

• At least 3 years of coding, medical record chart review, and risk adjustment data validation experience, or equivalent education and experience
• Certified Coding Specialist (CCS), Certified Coding Specialist - Physician-based (CCS-P), or Certified Professional Coder (CPC) certification
• Proficiency in Microsoft Office suite and applicable software programs
• Ability to work independently in a fast-paced, deadline-driven environment
• Experience in cross-collaborative work in a highly matrixed environment