Risk Adjustment Coding Auditor

TEKsystems•Phoenix, AZ

4d•$32 - $37•Remote

About The Position

We are seeking a detail-oriented Risk Adjustment Coding Auditor to support the accuracy, integrity, and compliance of clinical coding data across risk adjustment programs. In this role, you will conduct audits, review medical record documentation, identify coding opportunities, and provide guidance on coding accuracy to help support compliant reporting and appropriate reimbursement. The ideal candidate will bring extensive HCC coding and risk adjustment auditing experience, strong analytical skills, and a thorough understanding of Medicare, Medicaid, and ACA risk adjustment models.

Requirements

7+ years of related professional experience.
5+ years of HCC coding experience utilizing inpatient and outpatient coding guidelines.
5+ years of experience auditing risk adjustment records.
1+ year of experience working in a production-based environment.
CRC (Certified Risk Coder) certification in good standing.
Knowledge of Medicare, Medicaid, and ACA Commercial risk adjustment models.
Ability to interpret and apply coding policies, regulations, and guidelines.
Experience providing coding education, audit feedback, and trend analysis.
Intermediate proficiency with Microsoft Office Suite (Excel, Word, PowerPoint, and Outlook).
Strong organizational, analytical, and time management skills.
Ability to manage multiple priorities in a deadline-driven environment.
High school diploma or equivalent.

Nice To Haves

Bachelor's degree.
HEDIS and/or STARS experience.
Provider education experience.
Risk Adjustment Data Validation (RADV) experience.
CPMA or additional coding credentials.
Experience with NLP (Natural Language Processing) software.
RHIT or RHIA certification combined with strong risk adjustment coding experience.

Responsibilities

Perform retrospective and prospective chart reviews to evaluate risk adjustment diagnosis coding accuracy.
Audit medical records to verify the completeness, specificity, and appropriateness of reported diagnoses.
Review clinical documentation to ensure accurate HCC capture and risk adjustment reporting.
Evaluate coding practices for compliance with CMS guidelines, industry standards, and organizational policies.
Identify coding discrepancies, documentation gaps, and opportunities for improvement.
Provide written and verbal feedback regarding coding errors, trends, and audit findings.
Serve as a subject matter resource for risk adjustment coding and audit processes.
Support audit production goals and meet established turnaround times and deadlines.
Participate in risk mitigation reviews and special projects as assigned.
Maintain compliance with HIPAA, privacy, security, and regulatory requirements.
Stay current on coding regulations, risk adjustment methodologies, and industry updates.