Remote Risk Adjustment Coding Auditor

TEKsystems; Hanover (MD); On-site; USD 44,083 - 50,971; Full time

Benefits offered by this job

Medical, Dental & Vision

401(k) Retirement Plan

Life Insurance

PTO/Time Off

Job summary

TEKsystems is seeking a Risk Adjustment Coding Auditor to ensure the accuracy of coded clinical data and compliant reporting for risk adjustment programs. The role supports improved data integrity and safer reimbursement across Medicare, ACA, and Medicaid models.

The candidate will review charts, verify providers’ diagnoses, and apply CMS HCC guidelines while maintaining regulatory compliance and strong data governance in a remote contract setup.

Qualifications

• 7+ years of professional experience in risk adjustment or medical coding.
• 5+ years of HCC coding experience in inpatient and outpatient coding guidelines.
• 5+ years of experience auditing Risk Adjustment records.
• 1+ years working in a Production environment.
• CRC (Certified Risk Coder) in good standing.
• Knowledge of Medicare, ACA Commercial and Medicaid models.
• Ability to apply critical thinking to coding policy interpretation and implementation.
• Experience providing written and verbal guidance on coding errors and trends.
• MS Office (Word, Excel, PowerPoint & Outlook) proficiency.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Responsibilities

• Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices.
• Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements.
• Performs retrospective and prospective chart reviews to ensure accurate risk adjustment reporting.
• Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.
• Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
• Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.
• Contributes to audit and production efforts to meet business demand and workload priorities.
• Provide written and verbal guidance on coding errors to others.
• Meets audit deliverables within established timelines and deadlines.
• Assists with special projects such as risk mitigation reviews.
• Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.

Skills

Audit

CRC

Coding

Risk Adjustment

Health Insurance

Education

Bachelor's degree

Tools

MS Office

Job description

TEKsystems is seeking a Risk Adjustment Coding Auditor to ensure the accuracy of coded clinical data and compliant reporting for risk adjustment programs. The role supports improved data integrity and safer reimbursement across Medicare, ACA, and Medicaid models.

The candidate will review charts, verify providers’ diagnoses, and apply CMS HCC guidelines while maintaining regulatory compliance and strong data governance in a remote contract setup.