Sr. Risk Adjustment Auditor

Remotedxb; Dubai; On-site; AED 180,000 - 300,000; Full time

Job summary

Honest Health in Dubai is seeking an experienced risk-adjustment auditor to review CDI outputs and vendor coding for accuracy and compliance. You will identify HCC opportunities, deliver findings and corrective actions, and help ensure documentation aligns with claims.

Collaborate with CDI, coding, and leadership teams to improve workflows, educate providers on ICD-10-CM and risk adjustment, and travel up to 25% for education sessions.

Qualifications

• Requires a degree in Health Information Management, Nursing, or related field.
• 5+ years of risk adjustment, medical coding, CDI, or auditing experience.
• 2+ years in prospective and concurrent review risk adjustment coding and auditing.
• Direct experience with Medicare Advantage (Part C) risk adjustment models and HCC coding.
• CRC and CPC certifications required.

Responsibilities

• Audit third-party vendor coding and CDI outputs for accuracy and compliance.
• Audit internal CDI Specialist work, including chart reviews and reconciliation.
• Identify coding inaccuracies, unsupported diagnoses, and missed HCC opportunities.
• Deliver audit findings, trend analysis, and corrective action recommendations.
• Review completed encounters in post-visit, pre-billing window to validate documentation.
• Evaluate alignment between medical record documentation and draft claims.
• Assess diagnoses for ICD-10-CM specificity and MEAT criteria compliance.
• Translate audit findings into targeted provider and team education.
• Partner with CDI, coding, and leadership teams to improve workflows and policies.
• Design and facilitate education sessions on ICD-10-CM and risk adjustment compliance.

Skills

Risk adjustment auditing

Medical coding

HCC coding

CPC certification

CRC certification

Auditing

Education

Health Information Management or Nursing degree

CRC certification

CPC certification

Tools

EMR systems familiarity

CDI tools familiarity

Job description

Responsibilities

• Audit third-party vendor coding and CDI outputs to ensure accuracy and compliance
• Audit internal CDI Specialist work, including chart reviews and reconciliation
• Identify coding inaccuracies, unsupported diagnoses, and missed HCC opportunities
• Deliver audit findings, trend analysis, and corrective action recommendations
• Review completed encounters in the post-visit, pre-billing window to validate documentation
• Evaluate alignment between medical record documentation and draft claims
• Assess diagnoses for ICD-10-CM specificity and MEAT criteria compliance
• Translate audit findings into targeted provider and team education
• Partner with CDI, coding, and leadership teams to improve workflows and policies
• Design and facilitate education sessions on ICD-10-CM and risk adjustment compliance

Requirements

• Associate's or Bachelor's degree in Health Information Management, Nursing, or a related clinical field
• 5+ years of experience in risk adjustment, medical coding, CDI, or auditing
• 2+ years of experience in prospective and concurrent review risk adjustment coding and auditing
• Direct experience with Medicare Advantage (Part C) risk adjustment models and HCC coding
• CRC (Certified Risk Adjustment Coder) and CPC (Certified Professional Coder) certifications required
• Advanced knowledge of ICD-10-CM Official Guidelines and AHA Coding Clinic guidance
• Ability to travel up to 25% for provider education or team collaboration

Preferred Qualifications

• CCS, CCDS, RHIT, or RHIA certifications
• Experience auditing vendor-delivered work or CDI programs
• Familiarity with CDI workflows, EMR systems, and coding/audit tools

About the Company

At Honest Health, we believe in purpose and partnership to lead the transformation in primary care. Our team of healthcare experts and clinicians collaborates with a range of stakeholders to deliver innovative solutions that elevate care, control costs, and support long-term health.