Remote Medicare Risk Adjustment Auditor

Alignment Healthcare USA, LLC in; Orange (CA); Remote; USD 64,000 - 97,000; Full time

Job summary

Alignment Health seeks a Remote Risk Adjustment Compliance Auditor to conduct provider and coder level reviews, ensuring CMS risk adjustment data accuracy. The role develops tracking tools, reviews outcomes, and monitors corrective action plans related to RADV audits.

Responsibilities include monitoring coding prevalence, reviewing IPA procedures for compliance, and collaborating with Risk Adjustment Management to maintain data integrity and regulatory adherence.

Qualifications

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

Responsibilities

• Monitor coding prevalence reporting for outliers.
• Review IPA policies and procedures for compliance.
• Maintain tracking tool for Risk Adjustment compliance.
• Ensure compliance with federal, state & local regulations.
• Audit data with Risk Adjustment Management and corrective action plans.
• Represent the department in RADV and other risk adjustment audits.

Skills

Strategic planning

Leadership

Communication

Problem solving

Team collaboration

Education

Bachelor’s degree in business administration/healthcare management

Tools

Epic

Allscripts

EZCap

MS Office

MS Access

Job description

Alignment Health seeks a Remote Risk Adjustment Compliance Auditor to conduct provider and coder level reviews, ensuring CMS risk adjustment data accuracy. The role develops tracking tools, reviews outcomes, and monitors corrective action plans related to RADV audits.

Responsibilities include monitoring coding prevalence, reviewing IPA procedures for compliance, and collaborating with Risk Adjustment Management to maintain data integrity and regulatory adherence.