Risk Adjustment Auditor: Elevate Healthcare Coding

martin; Portland (ME); Remote; USD 76,000 - 93,000; Full time

Benefits offered by this job

Medical insurance

Paid time off

Job summary

Martin's Point Health Care is seeking a Risk Adjustment Auditor to monitor, audit, and validate coding and documentation for risk adjustment. This role ensures accurate ICD-10 coding across professional, inpatient, and outpatient services.

You will review medical records, stay current with HIPAA and CMS guidelines, and collaborate with care teams to maintain compliance and high-quality data. Requires CPC/COC or CRC certification and 5+ years of clinical coding experience in risk adjustment.

Qualifications

• Associates degree or combination of relevant education and experience.
• 5+ years of clinical coding experience with risk adjustment coding.
• CPC/COC or CRC certification required with other certifications considered on a case-by-case basis.

Responsibilities

• Conducts coding, documentation, and validation audits of medical records and clinical data for risk adjustment vendors and other targeted universes to ensure compliance.
• Reviews patient medical records to identify relevant diagnoses and capture information for accurate coding.
• Assigns appropriate ICD-10 codes to document patient conditions and ensure compliance with guidelines and regulations.
• Stays updated with HIPAA, coding guidelines, regulations, and compliance standards to maintain accuracy.
• Meets team performance metrics for quantity and quality.
• Conducts RADV/IPM Chart Review duties as assigned.
• Participates in Coding Advisory Committee.

Skills

ICD-10 coding

Auditing

Medical terminology

Communication

Problem solving

Organizational skills

Independent work

Education

Associates degree or equivalent experience

Job description

Martin's Point Health Care is seeking a Risk Adjustment Auditor to monitor, audit, and validate coding and documentation for risk adjustment. This role ensures accurate ICD-10 coding across professional, inpatient, and outpatient services.

You will review medical records, stay current with HIPAA and CMS guidelines, and collaborate with care teams to maintain compliance and high-quality data. Requires CPC/COC or CRC certification and 5+ years of clinical coding experience in risk adjustment.