Hybrid Risk Adjustment Auditor II — Mentor & CPC/CRC

Cambia Health; Medford (OR); Hybrid; USD 58,000 - 78,000; Full time

Benefits offered by this job

Work from home options

Travel opportunities

Job summary

Cambia Health seeks a Risk Adjustment Auditor to perform retrospective/prospective chart reviews for accurate risk adjustment reporting across multiple offices. The role emphasizes improving coding quality, identifying trends, and coordinating with the coding team to implement corrective actions.

The position requires healthcare-related education with experience in risk adjustment and coding guidelines, plus strong analytical and communication skills.

Qualifications

• Associate degree in Healthcare or related field required.
• 1 year of experience in clinical coding or auditing for Auditor I.
• 3 years of experience in clinical coding or auditing for Auditor II.
• Risk Adjustment, HCC or Inpatient coding experience required.

Responsibilities

• Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.
• Performs quality reviews of vendor coding in support of the risk adjustment process.
• Verifies accuracy of provider-reported diagnosis codes based on medical records.
• Reviews CMS HCC and HHS HCC categories to identify complete and accurate code capture.
• Identifies trends in provider and vendor coding and documentation and partners with leadership to develop intervention strategies.
• Supports process and quality improvement initiatives and ensures regulatory compliance.

Skills

Risk adjustment

HCC

Coding accuracy

Quality audits

CMS guidelines

Communication

AI tools experience

Education

Associate degree in Healthcare or related field

Tools

Word

Excel

Outlook

Job description

Cambia Health seeks a Risk Adjustment Auditor to perform retrospective/prospective chart reviews for accurate risk adjustment reporting across multiple offices. The role emphasizes improving coding quality, identifying trends, and coordinating with the coding team to implement corrective actions.

The position requires healthcare-related education with experience in risk adjustment and coding guidelines, plus strong analytical and communication skills.