Certified Risk Coder Auditor

Job Summary

To ensure the accuracy and compliance of diagnosis coding in risk adjustment programs, the contract-to-hire Certified Risk Coder Auditor will conduct medical record audits, validate diagnosis codes, and provide coding guidance while working remotely.

Key Responsibilities

• Perform prospective and retrospective medical record reviews and audits
• Validate diagnosis code accuracy, completeness, specificity, and appropriateness based on provider documentation
• Identify coding and documentation deficiencies and provide written and verbal feedback

Required Qualifications

• 7+ years of relevant professional experience
• 5+ years of HCC/Risk Adjustment coding experience utilizing inpatient and outpatient coding guidelines
• 5+ years of Risk Adjustment auditing experience
• CRC (Certified Risk Coder) certification in good standing
• Strong knowledge of Medicare, ACA Commercial, and Medicaid risk adjustment models