Remote Medicare Risk Adjustment Auditor (CPC/CCS/CCS-P)

Alignment Health; Northern (KY); Hybrid; USD 64,000 - 97,000; Full time

Job summary

Alignment Health is seeking a Medicare Risk Adjustment Compliance Auditor (remote) to conduct provider and coder reviews and audits, ensuring accurate CMS risk adjustment data submissions. You will develop tracking tools, review outcomes, and monitor corrective action plans with Risk Adjustment Management.

Requirements include a CPC, CCS, and CCS-P certification, plus at least 3 years of coding experience in a medical group or health plan.

Qualifications

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

Responsibilities

• Monitor coding prevalence reporting for coding outliers.
• Review IPA policies and procedures to ensure program compliance.
• Track internal coding staff accuracy and coding vendor accuracy.
• Collaborate with Risk Adjustment Management on data validation and RADV audits.
• Maintain comprehensive tracking tools for Risk Adjustment Compliance.
• Ensure compliance with applicable federal, state and local regulations.

Skills

CPC/CCS/CCS-P

Epic

Allscripts

EZCap

MS Office

MS Access

Communication

Leadership

Problem solving

Report analysis

Education

Bachelor’s degree in business administration or health care management

Tools

Epic

Allscripts

EZCap

Job description

Alignment Health is seeking a Medicare Risk Adjustment Compliance Auditor (remote) to conduct provider and coder reviews and audits, ensuring accurate CMS risk adjustment data submissions. You will develop tracking tools, review outcomes, and monitor corrective action plans with Risk Adjustment Management.

Requirements include a CPC, CCS, and CCS-P certification, plus at least 3 years of coding experience in a medical group or health plan.