Remote Risk Adjustment Coding Auditor | HCC Expert

DaMar Staffing; United States; On-site; USD 48,000 - 52,000; Part time

Job summary

Dahl Consulting is partnering with a leading health insurance organization in Minnesota to hire a Risk Adjustment Coding Auditor on a contract basis. The role focuses on ensuring accurate coded clinical data to support compliant reporting and appropriate reimbursement across Medicare, Medicaid and ACA lines of business.

You will review risk adjustment codes for accuracy, protect patient records, and provide guidance on coding errors while meeting project deadlines.

Qualifications

• 7+ years of related professional experience.
• 5+ years of HCC coding experience utilizing 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, or ability to obtain certification within the first 6 months.
• Intermediate knowledge of risk adjustment Medicare, ACA Commercial, and Medicaid models.
• Ability to provide written and verbal guidance on coding errors.
• Proficient in MS Office (Word, Excel, PowerPoint, Outlook).
• High school diploma (or equivalent) and legal authorization to work in the U.S.

Responsibilities

• Evaluating risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices.
• Protecting patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements.
• Performing retrospective and prospective chart reviews to ensure accurate risk adjustment reporting.
• Verifying and ensuring the accuracy, completeness, specificity, and appropriateness of provider-reported diagnosis codes based on medical record documentation.
• Reviewing medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
• Maintaining knowledge of relevant regulatory mandates and ensuring activities comply with requirements.
• Contributing to audit and production efforts to meet business demand and workload priorities.
• Providing written and verbal guidance on coding errors to others.
• Meeting audit deliverables within established timelines and deadlines.
• Assisting with special projects, such as risk mitigation reviews.
• Serving as a subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.

Job description

Dahl Consulting is partnering with a leading health insurance organization in Minnesota to hire a Risk Adjustment Coding Auditor on a contract basis. The role focuses on ensuring accurate coded clinical data to support compliant reporting and appropriate reimbursement across Medicare, Medicaid and ACA lines of business.

You will review risk adjustment codes for accuracy, protect patient records, and provide guidance on coding errors while meeting project deadlines.