Remote Medicare Risk Adjustment Auditor

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

Job summary

Alignment Health seeks a Remote Risk Adjustment Compliance Auditor to perform provider and coder reviews, monitor CMS submissions, and support RADV audits. You will track outcomes, maintain compliance tools, and coordinate with Risk Adjustment Management to improve data accuracy.

The role requires CPC/CCS/CCS-P, 3+ years of coding experience, and strong communication and leadership skills, with experience using Epic, Allscripts or EZCap. Competitive pay and benefits.

Qualifications

• Bachelor’s degree or 4 years of equivalent experience.
• CPC, CCS, CCS-P certification required.
• Experience in risk adjustment and audits.
• Strong communication, leadership and teaching ability.
• Proficient with Epic, Allscripts or EZCap systems.

Responsibilities

• Monitor coding prevalence reporting for coding outliers.
• Review IPA policies to ensure program compliance.
• Track coding staff and vendor accuracy for CMS submissions.
• Collaborate with Risk Adjustment Management on data validation and RADV audits.
• Maintain a comprehensive risk adjustment compliance tracking tool.
• Ensure compliance with federal, state and local regulations, policies.

Skills

Risk adjustment

Leadership

Communication

Problem solving

Attention to detail

Education

Bachelor's degree in business administration

Experience in lieu of education (4 years)

Tools

Epic

Allscripts

EZCap

MS Office

MS Access

Job description

Alignment Health seeks a Remote Risk Adjustment Compliance Auditor to perform provider and coder reviews, monitor CMS submissions, and support RADV audits. You will track outcomes, maintain compliance tools, and coordinate with Risk Adjustment Management to improve data accuracy.

The role requires CPC/CCS/CCS-P, 3+ years of coding experience, and strong communication and leadership skills, with experience using Epic, Allscripts or EZCap. Competitive pay and benefits.