Remote Medicare Risk Adjustment Auditor

Alignment Health; United States; 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, ensuring accurate risk adjustment data is submitted to CMS. You will develop tracking tools, review outcomes, and monitor corrective action plans, while maintaining compliance with federal, state, and local regulations.

Responsibilities include monitoring coding accuracy, partnering with Risk Adjustment Management on data validation, and ensuring high-quality submissions.

Qualifications

• Bachelor’s degree in business administration, health care management or related field (or 4 years equivalent experience).
• Certified Coder required - CPC, CCS & CCS-P.
• Experience with risk adjustment and CMS processes preferred.
• Strong analytical and leadership skills; ability to communicate with diverse teams.

Responsibilities

• Monitor coding prevalence and outliers in risk adjustment data.
• Ensure program compliance with IPA policies and CMS requirements.
• Maintain tracking tools and monitor corrective action plans.
• Collaborate with Risk Adjustment Management on data validation and RADV audits.
• Protect patient PHI in accordance with HIPAA standards.

Skills

Risk mitigation planning

Communication

Leadership

Problem solving

Statistical analysis

HIPAA compliance

MS Office

Education

Bachelor’s degree in business administration or health care management

Tools

Epic

Allscripts

EZCap

Job description

Alignment Health is seeking a Remote Risk Adjustment Compliance Auditor to conduct provider and coder level reviews, ensuring accurate risk adjustment data is submitted to CMS. You will develop tracking tools, review outcomes, and monitor corrective action plans, while maintaining compliance with federal, state, and local regulations.

Responsibilities include monitoring coding accuracy, partnering with Risk Adjustment Management on data validation, and ensuring high-quality submissions.