Risk Adjustment Coding Auditor
About The Position
The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role identifies coding and documentation gaps, mitigates financial and regulatory risk, improves data integrity, and provides subject matter expertise to support consistent application of coding standards and informed enterprise decision-making. This is a fully remote contract position based out of Chicago, Illinois. The stated pay range is $32.00–$37.00 per hour. Individual compensation depends on factors including qualifications, skills, relevant experience, job knowledge, geographic location, and internal equity. Benefits may be available subject to eligibility, job classification, length of employment, and applicable plan terms.
Requirements
- At least 5 years of HCC coding experience using inpatient and outpatient coding guidelines.
- At least 5 years of experience auditing risk adjustment records.
- At least 1 year of experience working in a production environment.
- CRC (Certified Risk Coder) certification in good standing.
- Intermediate knowledge of risk adjustment Medicare, ACA Commercial, and Medicaid models.
Responsibilities
- Evaluate risk adjustment codes for accuracy, consistency, and alignment with coding standards and best practices.
- Protect patient records and audit information by complying with HIPAA, privacy, security, and regulatory requirements.
- Perform retrospective and prospective chart reviews to ensure accurate risk adjustment reporting.
- Verify the accuracy, completeness, specificity, and appropriateness of provider-reported diagnosis codes against medical record documentation.
- Review medical records to identify complete and accurate diagnosis code capture based on CMS HCC categories.
- Maintain knowledge of relevant regulatory mandates and ensure activities comply with requirements.
- Contribute to audit and production efforts to meet business demand and workload priorities.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Critical Illness, Accident, and Hospital coverage
- 401(k) Retirement Plan with pre-tax and Roth post-tax contributions
- Voluntary Life and AD&D insurance for the employee and dependents
- Short- and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
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What This Job Offers
Career Level
Senior
Education Level
No Education Listed
