Medicare ACO Coding Auditor & Quality Reviewer

Cano Health LLC; United States; Hybrid; USD 65,000 - 95,000; Full time

Job summary

Cano Health LLC is seeking an ACO Coding Auditor to review medical records and map diagnoses to Medicare Risk codes, ensuring accurate CMS risk adjustment. The role requires collaboration with practices to improve coding quality and adherence to HCC guidelines.

The candidate will perform on-site and remote audits, interpret medical documentation, and support training to reduce gaps in coding and drive compliant reimbursement across CMS and commercial payer networks.

Qualifications

• High School diploma or GED required.

Responsibilities

• Conduct on-site and remote clinical validation audits of medical records to capture Medicare Risk codes.
• Provide guidance to practice teams to improve MRA coding proficiency and CMS risk adjustment accuracy.
• Verify coding accuracy based on CMS HCC categories and ensure compliance with Federal, State, and local regulations.

Skills

Attention to detail

Critical thinking

Communication skills

Team player

Education

CPC

CRC

CCS-P

CCS-H

RHIT

High School diploma

Tools

ICD-10 coding

ICD-9 coding

CPT coding

Medical documentation review

Job description

Cano Health LLC is seeking an ACO Coding Auditor to review medical records and map diagnoses to Medicare Risk codes, ensuring accurate CMS risk adjustment. The role requires collaboration with practices to improve coding quality and adherence to HCC guidelines.

The candidate will perform on-site and remote audits, interpret medical documentation, and support training to reduce gaps in coding and drive compliant reimbursement across CMS and commercial payer networks.