Remote Medicare Risk Adjustment Auditor

E2E Alignment Healthcare USA, LLC; California (MO); Remote; USD 64,000 - 97,000; Full time

Job summary

Alignment Health is seeking a Remote Risk Adjustment Compliance Auditor to conduct provider and coder level reviews and audits, ensuring CMS risk adjustment data accuracy. The role develops tracking tools, monitors audit outcomes, and supports corrective action plans across risk adjustment programs.

Required: Bachelor’s degree in business administration or healthcare management or 3+ years coding in a medical group/health plan, plus CPC/CCS/CCS-P certification.

Qualifications

• Bachelor’s degree in business administration, health care management or related field, or 4 years additional experience in lieu of education.
• Certified Coder required - CPC, CCS & CCS-P.
• Minimum 3 years of professional coding experience in a medical group or health plan setting.

Responsibilities

• Monitors coding prevalence reporting for coding outliers.
• Reviews IPA Policies and procedures to ensure programs are compliant.
• Monitors internal coding staff accuracy percentages to ensure they are tracked and maintained.
• Monitors coding vendor’s accuracy percentages to ensure the coding accuracy and quality of the data submitted to CMS.
• Works with Risk Adjustment Management on any data validation and/or RADV coding audit to ensure completeness and accuracy of submissions to CMS.
• Maintains a comprehensive tracking and management tool for Risk Adjustment Compliance.
• Ensures compliance with all applicable federal, state & local regulations and organizational standards.
• Represents the department in RADV and other risk adjustment related audits.

Skills

Risk adjustment

Certified coder (CPC/CCS/CCS-P)

Auditing

Regulatory compliance

Data analysis

Education

Bachelor’s degree in business administration / healthcare management

Tools

Epic

Allscripts

EZCap

MS Office

MS Access

Job description

Alignment Health is seeking a Remote Risk Adjustment Compliance Auditor to conduct provider and coder level reviews and audits, ensuring CMS risk adjustment data accuracy. The role develops tracking tools, monitors audit outcomes, and supports corrective action plans across risk adjustment programs.

Required: Bachelor’s degree in business administration or healthcare management or 3+ years coding in a medical group/health plan, plus CPC/CCS/CCS-P certification.