Medicare Risk-Adjustment Coding Auditor

40000 Sanford Health Plan; Wisconsin; Hybrid; USD 30,000 - 48,000; Full time

Job summary

Sanford Health is seeking a Coding Audit Specialist to ensure accurate risk adjustment coding across Medicare Advantage, ACA/Exchange and BadgerCare Plus populations. You will audit medical records, apply CPT/ICD-10 guidelines, and present concise audit outcomes to leadership.

Ideal candidates have CPC certification within a year, 3 years in health insurance or auditing, and strong knowledge of CMS guidelines, documentation standards, and data analysis.

Qualifications

• High school diploma or equivalent; knowledge of anatomy/physiology and medical terminology.
• 3 years of experience in health insurance, compliance, quality assurance, or auditing.
• Certified Professional Coder (CPC) certification within one year of hire.

Responsibilities

• Audit medical records to ensure correct codes for Medicare Advantage, ACA/Exchange, and BadgerCare Plus.
• Develop and monitor risk adjustment auditing program with leadership.
• Review provider documentation and verify code assignment to ensure documentation supports reported codes.

Skills

Medical coding knowledge

CMS guidelines knowledge

Documentation review

Analytical skills

Education

Associate Degree in coding/health-related field

Certified Professional Coder (CPC) certification

Tools

Microsoft Word

Excel

Access

Job description

Sanford Health is seeking a Coding Audit Specialist to ensure accurate risk adjustment coding across Medicare Advantage, ACA/Exchange and BadgerCare Plus populations. You will audit medical records, apply CPT/ICD-10 guidelines, and present concise audit outcomes to leadership.

Ideal candidates have CPC certification within a year, 3 years in health insurance or auditing, and strong knowledge of CMS guidelines, documentation standards, and data analysis.