Coding Auditor

DaMar Staffing; Tulsa (OK); On-site; USD 55,000 - 75,000; Full time

Job summary

CommunityCare seeks a Risk Adjustment Auditor to review medical records and ensure accurate diagnosis capture under CMS guidelines and ICD-10-CM standards.

You will perform chart reviews, identify coding gaps, support the coding team with findings, monitor RADV compliance, and help drive documentation quality across the organization.

Qualifications

• Knowledge of CMS-HCC and related risk adjustment models.
• Knowledge of ICD-10-CM coding guidelines.
• Familiarity with RADV requirements.
• Proficiency with EMR systems and Microsoft Office.
• High attention to detail and strong analytical skills.
• Clear written and verbal communication.
• Ability to work independently and meet deadlines.
• Strong organizational skills and integrity.
• Completion of Health Care Sanctions background check.

Responsibilities

• Review bi-directional medical records to validate risk-adjusted diagnoses (HCCs) per CMS guidelines.
• Ensure documentation supports coded conditions according to ICD-10-CM and payer guidelines.
• Identify unsupported diagnoses, over/under coding, and documentation gaps.
• Provide audit findings and recommendations to coding teams and leadership.
• Monitor RADV compliance and report trends and performance metrics.
• Collaborate with providers and staff to improve documentation quality and coding accuracy.
• Assist education and training on risk adjustment best practices.

Skills

CMS-HCC knowledge

ICD-10-CM knowledge

RADV knowledge

EMR systems

Microsoft Office

Attention to detail

Analytical thinking

Verbal & written communication

Independent worker

Organizational skills

Education

Two years risk adjustment experience

Coding certification (CPC/CRC/CCS)

Bachelor's degree preferred

Job description

Risk Adjustment Auditor

The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity.

Key responsibilities include:

• Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements.


• Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines.


• Identify unsupported diagnoses, over coding, under-coding, and documentation gaps.


• Provide detailed audit findings and recommendations to coding teams, providers, and leadership.


• Monitor compliance with CMS Risk Adjustment Data Validation (RADV) standards.


• Track and report audit results, trends, and performance metrics.


• Collaborate with coding staff, providers, and operations teams to improve documentation quality and coding accuracy.


• Assist with education and training initiatives related to risk adjustment and documentation best practices.


• Maintain confidentiality and ensure compliance with HIPAA regulations.


• Meet daily and weekly productivity goals and quality standards set by the supervisor.


• Perform other job-related duties as required or assigned.

Qualifications include:

• Knowledge of CMS-HCC and HHS-HCC risk adjustment model.


• Knowledge of ICD-10-CM coding guidelines.


• Knowledge of RADV requirements.


• Proficiency in EMR systems and Microsoft Office (Excel preferred).


• High attention to detail.


• Strong analytical and critical thinking skills.


• Clear written and verbal communication.


• Ability to work independently and meet deadlines.


• Strong organizational skills.


• Integrity and commitment to compliance.


• Successful completion of Health Care Sanctions background check.

Education/experience includes:

• A minimum of two years of risk adjustment coding or auditing experience.


• Experience reviewing medical records across multiple specialties.


• Certified Professional Coder (CPC), CRC, CCS, or equivalent coding certification.


• Bachelor's degree in Health Information Management or related field preferred.


• Previous auditing experience in Medicare Advantage and ACA preferred.


• Experience with internal audit programs or payer audits preferred.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin.