Remote Coding Audit Specialist – Risk Adjustment

Good Samaritan Society; Northern (KY); Hybrid; USD 29,000 - 48,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k) retirement plan

Paid time off

Job summary

Sanford Health is seeking a Coding Audit Specialist to perform quality assurance on CMS and DHS risk adjustment data. The role involves auditing medical records, identifying coding deficiencies, and supporting a continuous monitoring program for Medicare Advantage and ACA/Exchange populations.

The candidate will maintain knowledge of CPT, ICD-9/10, HCPCS, and CMS policy requirements, while ensuring documentation aligns with reported codes.

Qualifications

• High school diploma or equivalent.
• Knowledge of anatomy/physiology and medical terminology.
• Completion of courses in Current Procedural Terminology and ICD-9/ICD-10 coding.
• Associate degree preferred.
• Three years of experience in health insurance, compliance, quality assurance, or auditing.
• Knowledge of CMS guidelines affecting Medicare Advantage, HHS-ACA and DHS/BadgerCare.
• Certification as CPC and/or CRAC within one year of hire.

Responsibilities

• Audit medical record documentation to ensure correct coding for Medicare Advantage, ACA/Exchange and BadgerCare Plus populations.
• Develop and monitor risk adjustment audits and outcomes to support leadership decisions.
• Ensure documentation supports reported codes per CPT, ICD-9/10 guidelines and CMS policies.
• Identify coding deficiencies and present concise audit findings to management.

Skills

Auditing

Coding accuracy

CMS guidelines

Microsoft Word

Microsoft Excel

Education

Associate degree in coding or health-related field

Certified Professional Coder (CPC)

Certified Risk Adjustment Coder (CRAC)

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Job description

Sanford Health is seeking a Coding Audit Specialist to perform quality assurance on CMS and DHS risk adjustment data. The role involves auditing medical records, identifying coding deficiencies, and supporting a continuous monitoring program for Medicare Advantage and ACA/Exchange populations.

The candidate will maintain knowledge of CPT, ICD-9/10, HCPCS, and CMS policy requirements, while ensuring documentation aligns with reported codes.