Remote Medicare Risk Adjustment Compliance Auditor

Alignment Health

Sacramento (CA)

Remote

USD 64,000 - 97,000

Full time

7 days ago

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Job summary

Alignment Health is seeking a Remote Risk Adjustment Compliance Auditor to conduct provider and coder level reviews ensuring CMS risk adjustment data accuracy. The role develops tracking tools, analyzes audit outcomes, and monitors corrective actions aligned with RADV projects.

The position requires a CPC/CCS/CCS-P certification, 3+ years coding experience, and familiarity with Epic/Allscripts/EZCap. Strong analytical and communication skills are essential as you support compliance and process

Qualifications

Bachelor’s degree in business or health care management or 4 years of related experience.
Certified coder training (CPC/CCS/CCS-P) required.
Experience with risk adjustment and CMS audits.
Ability to monitor compliance with federal, state and local regulations.
Strong verbal and written communication skills.

Responsibilities

Monitors coding prevalence reporting for coding outliers.
Reviews IPA policies and procedures to ensure programs are compliant.
Monitors internal coding staff accuracy percentages to ensure they are tracked and maintained.
Monitors coding vendor’s accuracy percentages to ensure the coding accuracy and quality of the data submitted to CMS.
Works with Risk Adjustment Management on data validation and RADV coding audits for completeness and accuracy.
Maintains a comprehensive tracking tool for Risk Adjustment Compliance.
Ensures compliance with applicable regulations and organizational standards.