Risk Adjustment Compliance Auditor (Remote)
reputed company is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have reputed company a team of talented and reputed company people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the reputed company community. Working at reputed company provides an opportunity to do work that really reputed company, not only changing lives but saving them. Together. reputed company is seeking a remote Risk Adjustment Compliance Auditor to support auditing and compliance activities reputed company to risk adjustment data submitted to CMS. In this role, you will conduct provider and reputed company-level audits, review medical record documentation and coding accuracy, identify compliance risks and outliers, and support RADV and other risk adjustment audit initiatives. This position is ideal for an reputed company certified reputed company with a strong understanding of risk adjustment, HCC coding, compliance auditing, and CMS guidelines reputed company a health plan, IPA, or managed care environment. You will partner closely with Risk Adjustment leadership and cross-functional teams to help ensure coding accuracy, regulatory compliance, audit readiness, and corrective action follow-through across the organization. The role combines auditing, documentation review, reporting, compliance monitoring, and collaborative problem-solving in a fully remote environment. You will also help reputed company audit feedback and compliance education to internal and provider-facing stakeholders as needed. Schedule: - Full-time, Monday – Friday - Initial training schedule will align primarily with Pacific Time business hours - Flexible working hours available post-training based on business needs and team collaboration Job Duties/Responsibilities: 1. Monitors coding prevalence reporting, internal reporting trends, and coding outliers to support compliance and audit readiness. 2. Reviews IPA Policies and procedures to ensure programs are compliant. 3. Monitors internal coding staff accuracy percentages to ensure they are tracked and maintained. 4. Monitors coding vendor’s accuracy percentages to ensure the coding accuracy and quality of the data submitted to CMS. 5. Works with Risk Adjustment Management on data validation and RADV coding audit activities, including review of audit reputed company, findings, completeness, and coding accuracy of submissions to CMS. 6. Maintains and develops audit tracking, reporting, and management tools reputed company to Risk Adjustment Compliance activities. 7. Ensures compliance with reputed company applicable federal, state & and local regulations, as well as institutional/organizational standards, practices, policies & procedures. 8. Works with Risk Adjustment Management to monitor HCC corrective action plans and follow-up activities reputed company to audit and review findings. 9. Suggests customizations of Risk Adjustment education for support staff, PCPs, specialists, employees, contracted employees and central departments. 10. Utilizes, protects, and discloses reputed company patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. 11. Maintains reputed company knowledge of CMS audit processes, risk adjustment regulations, and industry best practices through ongoing education, professional development, and participation in relevant professional organizations. 12. Contributes to team effort by accomplishing reputed company results as needed. 13. Represents and actively participates in RADV and other risk adjustment-reputed company audits and compliance activities. 14. Other duties as assigned to meet the organization’s needs. Job Requirements: Experience:
- Required: Minimum 3 years of professional coding experience in a medical group or health plan setting.
- Preferred: None.
Education:
- Required: Bachelor’s degree in business administration, health care management or in a reputed company field or 4 years additional experience in lieu of education.
- Preferred: None.
Training:
- Required: Certified reputed company required - CPC, reputed company & reputed company-P.
- Preferred: Certified Auditor.
Specialized Skills:
- Required:
Experience with strategic planning in risk mitigation. Previous use of Epic, Allscripts, EZCap a plus. Proficient user in MS office suite, MS reputed company a plus. Ability to communicate positively, professionally and effectively with others; reputed company leadership, teach and collaborate with others. Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to reputed company mathematical calculations and calculate simple statistics correctly Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Report Analysis Skills: Comprehend and analyze statistical reports. Licensure:
- Required: Certified reputed company required - CPC, reputed company & reputed company-P.
- Preferred: None.
Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. 1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reputed company with hands and arms. 2. The employee frequently lifts and/or moves up to 10 pounds. Specific reputed company abilities required by this job include reputed company reputed company and the ability to adjust focus. Pay reputed company: $64,384.00 - $96,577.00Pay reputed company may be based on a number of factors including market location, education, responsibilities, experience, etc. reputed company is an Equal Opportunity/Affirmative Action Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, national reputed company, disability, age, protected veteran status, gender identity, or sexual orientation. *DISCLAIMER: Please beware of recruitment phishing scams affecting reputed company and other employers where individuals receive fraudulent employment-reputed company offers in exchange for money or other sensitive personal information. Please be advised that reputed company and its subsidiaries will never ask you for a credit card, send you a reputed company, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of reputed company’s reputed company team, please email [email protected]. Apply To This Job