Remote Risk Adjustment Audit Specialist

Apex Systems; Phoenix (AZ); Remote; USD 80,000 - 110,000; Full time

Benefits offered by this job

Medical, dental, vision, life, and DIS

401K with company match

HSA option

Employee Assistance Program (EAP)

Certification discounts and courses

Career coaching and consultant support

Job summary

Everforth Apex Systems is seeking a Risk Adjustment Audit Reviewer in Phoenix (Remote) to serve as a coding compliance resource for Risk Adjustment initiatives. You will review audit findings, educate on opportunities, and support CMS audits with documentation.

The role requires deep ICD-10 coding knowledge, CMS Risk Adjustment guidelines, and CPC or AHIMA certification, with emphasis on communicating findings to leadership and internal staff.

Qualifications

• Bachelor's degree in healthcare administration or related field, or equivalent experience.
• Four years of coding or audit experience, including two years in Risk Adjustment Coding.
• Knowledge of outpatient and inpatient guidelines.
• Deep understanding of ICD-10 Coding Guidelines, CMS Risk Adjustment guidelines, Anatomy/Physiology, the disease process, and medical terminology.
• Certified Professional Coder (CPC) OR AHIMA certification is required.

Responsibilities

• Review audit findings and educate on identified opportunities.
• Communicate effectively with leaders, peers, and vendors.
• Utilize deep knowledge of ICD-10 coding and risk adjustment guidelines.
• Immediately report adverse audit trends and potential risk areas to leadership.
• Provide education to internal staff based on audit findings.
• Effectively communicate the audit process and results to leaders.
• Audit all vendor risk adjustment activity.
• Adhere to stringent timelines consistent with project deadlines.

Skills

ICD-10 guidelines

CMS Risk Adjustment guidelines

Anatomy/Physiology

Disease process

Medical terminology

Organizational skills

Interpersonal skills

CPC certification

AHIMA certification

Education

Bachelor's degree in healthcare administration

Job description

Everforth Apex Systems is seeking a Risk Adjustment Audit Reviewer in Phoenix (Remote) to serve as a coding compliance resource for Risk Adjustment initiatives. You will review audit findings, educate on opportunities, and support CMS audits with documentation.

The role requires deep ICD-10 coding knowledge, CMS Risk Adjustment guidelines, and CPC or AHIMA certification, with emphasis on communicating findings to leadership and internal staff.