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

United States Digital Space LLC; United States; Remote; USD 64,000 - 97,000; Full time

Job summary

Alignment Healthcare is seeking a Remote Risk Adjustment Compliance Auditor to conduct provider and coder reviews ensuring accurate risk adjustment data is submitted to CMS. You will develop tracking tools, review outcomes, and participate in audits related to risk adjustment, with emphasis on PHI protection and HIPAA compliance.

Requirements include a minimum of 3 years of professional coding experience in a medical group or health plan setting, a Bachelor’s degree or equivalent experience, and

Qualifications

• Experience with strategic planning in risk mitigation.
• Certified Coder required (CPC/CCS/CCS-P).
• Experience using Epic/Allscripts/EZCap is a plus.
• Proficient in MS Office; MS Access a plus.
• Excellent written and verbal communication; leadership and collaboration.
• Analytical skills to interpret statistical reports and data.
• Ability to prioritize tasks and solve problems in a fast-paced environment.

Responsibilities

• Monitor coding prevalence reporting for coding outliers.
• Review IPA policies and procedures for compliance.
• Monitor internal coding staff accuracy percentages.
• Monitor coding vendor accuracy percentages.
• Collaborate with Risk Adjustment Management on data validation and RADV audits.
• Maintain a comprehensive RADV compliance tracking tool.
• Ensure compliance with applicable laws and internal standards.
• Suggest RADV education enhancements for staff and contractors.
• Protect PHI in line with HIPAA standards.
• Engage in ongoing education and professional development.

Skills

Strategic planning

Communication

Leadership

Team collaboration

Analytical thinking

Problem solving

Time management

Education

Bachelor’s degree in healthcare management or related field

Certified Coder (CPC/CCS/CCS-P)

Tools

Epic

Allscripts

EZCap

MS Office

MS Access

Job description

Alignment Healthcare is seeking a Remote Risk Adjustment Compliance Auditor to conduct provider and coder reviews ensuring accurate risk adjustment data is submitted to CMS. You will develop tracking tools, review outcomes, and participate in audits related to risk adjustment, with emphasis on PHI protection and HIPAA compliance.

Requirements include a minimum of 3 years of professional coding experience in a medical group or health plan setting, a Bachelor’s degree or equivalent experience, and