Remote Medicare Risk Adjustment Auditor | Certified Coder

Alignment Health; California City (CA); Remote; USD 64,000 - 97,000; Full time

Job summary

Alignment Health is seeking a remote MRA Coding Auditor to support QA audits of internal Coding Analysts and vendors, ensuring 95% HCC accuracy in data submissions to CMS. You will partner with Risk Adjustment Management on data validation, chart reviews, and process improvements.

The role requires 3+ years in Medicare Risk Adjustment coding, CCS/CCS-P/CPC/CRC certification, and experience with Epic/Allscripts/EZCap. Strong communication and analytical skills are essential.

Qualifications

• Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting.

Responsibilities

• Support QA audits of the internal Coding Analyst Team to validate coding and abstraction quality (target 95% HCC accuracy).
• Track and report QA on coding vendors and CMS submissions.
• Collaborate with Risk Adjustment Management on data validation and coding audits for CMS submissions.
• Analyze audit results and share findings for training and process improvements.
• Maintain HIPAA compliance and protect PHI in all audits.
• Ensure compliance with applicable laws and organizational standards.
• Maintain professional knowledge through CEUs and training.
• Perform other duties as assigned to meet organizational needs.

Skills

MS Office Suite

Excel

Word

Outlook

Epic

Allscripts

EZCap

Communication

Leadership

Team collaboration

Mathematical skills

Reasoning skills

Problem solving

Report analysis

Education

High School Diploma or GED

Bachelor’s degree in Business Administration or Healthcare Management

Medical Coding training program

Tools

Epic

Allscripts

EZCap

Job description

Alignment Health is seeking a remote MRA Coding Auditor to support QA audits of internal Coding Analysts and vendors, ensuring 95% HCC accuracy in data submissions to CMS. You will partner with Risk Adjustment Management on data validation, chart reviews, and process improvements.

The role requires 3+ years in Medicare Risk Adjustment coding, CCS/CCS-P/CPC/CRC certification, and experience with Epic/Allscripts/EZCap. Strong communication and analytical skills are essential.