Auditor, Risk Adjustment (Remote)

Molina Healthcare; Vancouver (WA); Remote; USD 77,000 - 129,000; Full time

Job summary

A leading healthcare organization in Vancouver is seeking a Risk Adjustment Data Validation Specialist to develop and implement controls to minimize organizational risks. The ideal candidate will have at least 3 years’ experience in coding and risk adjustment validation, along with appropriate certifications. This role offers competitive benefits and compensation.

Benefits

Competitive benefits

Equal Opportunity Employer

Qualifications

• 3 years in coding, medical record review, and risk adjustment data validation.
• Active and unrestricted CCS, CCS-P, or CPC certification.

Responsibilities

• Assist in daily risk adjustment data validation activities.
• Support risk adjustment audit projects and evaluate results.
• Implement processes to ensure compliance with CMS regulations.

Skills

Risk adjustment data validation

Financial analysis

Audit management

CMS regulations compliance

Data integrity assurance

Education

Associate's degree

Tools

Data management systems

Job description

Job Description

The Risk Adjustment Data Validation Specialist develops, recommends, and implements controls and cost-effective approaches to minimize organizational risks. They identify and analyze potential sources of loss, estimate financial consequences, and ensure adequate protection through appropriate insurance coverage.

Knowledge/Skills/Abilities

• Assist in daily risk adjustment data validation activities, including progress tracking, chart retrieval, file transmissions, and adherence to timelines.
• Support risk adjustment audit projects to meet goals, milestones, and deliverables.
• Evaluate audit results to identify barriers, gaps, and opportunities for improvement; implement corrective actions.
• Act as an audit liaison with departments, health plans, and vendors.
• Develop and implement processes to ensure accuracy, completeness, and compliance with CMS regulations.
• Oversee RAPS and EDPS data transmissions; identify issues affecting data integrity.
• Identify data mining opportunities to minimize data gaps.
• Apply best practices to ensure accurate risk adjustment payments across markets.
• Perform monthly audits on internal coding specialists and external vendors.

Job Qualifications

• Required Education: Associate's degree.
• Required Experience: 3 years in coding, medical record review, and risk adjustment data validation.
• Required License/Certification: Active and unrestricted CCS, CCS-P, or CPC certification.

Preferred Education: Bachelor's Degree in Business Administration or Healthcare Management.

Current Molina employees interested in applying should do so via the intranet.

Molina Healthcare offers competitive benefits and compensation. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $128,519 annually. Actual pay may vary based on location, experience, education, and skills.