Remote Medicare Risk Adjustment Auditor (CRC)

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

Job summary

Alignment Health is a remote employer focused on seniors with chronic conditions. The MRA Coding Auditor role supports QA audits of internal Coding Analyst teams and external vendors, ensuring accurate data for CMS submissions and risk adjustment processes.

The position emphasizes training, data integrity, and collaboration with Risk Adjustment Management to improve coding accuracy and compliance with HIPAA, federal and state regulations.

Qualifications

• Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting required.
• High School Diploma or GED; completion of a Medical Coding training program.
• Preferred: Bachelor's degree in Business Administration, health Care Management or related field.
• Technical School or courses required to become a certified coder.

Responsibilities

• Supports QA audits of internal Coding Analyst Team to validate coding & abstracting quality (95% HCC accuracy).
• Tracks and reports progress of QA audits on coding vendors for CMS submissions.
• Works with Risk Adjustment Management on data validation/coding audits for CMS submissions.
• Analyzes and shares audit results to support training and process improvements.
• Maintains HIPAA compliance and protects patient PHI while performing duties.

Skills

MS Office

Epic

Allscripts

EZCap

Communication

Education

High School Diploma

Medical Coding training

Bachelor's degree

Tools

Epic

Allscripts

EZCap

Job description

Alignment Health is a remote employer focused on seniors with chronic conditions. The MRA Coding Auditor role supports QA audits of internal Coding Analyst teams and external vendors, ensuring accurate data for CMS submissions and risk adjustment processes.

The position emphasizes training, data integrity, and collaboration with Risk Adjustment Management to improve coding accuracy and compliance with HIPAA, federal and state regulations.