Risk Adjustment Auditor: Precision Coding & Compliance

CommUnityCare; Tulsa (OK); On-site; USD 65,000 - 90,000; Full time

Job summary

CommUnityCare is seeking a Risk Adjustment Auditor to review medical records and documentation for accurate diagnosis capture in line with CMS risk adjustment guidelines and ICD-10-CM standards.

The role involves bi-directional reviews, identifying coding gaps, and collaborating with coding teams and clinicians to enhance documentation quality and compliance. Requires CPC/CRC/CCS or equivalent and at least two years of experience.

Qualifications

• Two years of risk adjustment coding or auditing experience.
• Experience reviewing medical records across multiple specialties.
• Certified coding credentials (CPC/CRC/CCS) or equivalent.
• Knowledge of CMS-HCC, ICD-10-CM guidelines, and RADV requirements.
• Proficiency with EMR systems and Microsoft Office.

Responsibilities

• Perform bidirectional retrospective and prospective medical record reviews to validate risk-adjusted diagnoses (HCCs) per CMS guidelines.
• Ensure documentation supports coded conditions per ICD-10-CM and payer guidelines.
• Identify unsupported diagnoses, over- or under-coding, and documentation gaps.
• Provide audit findings and recommendations to coding teams, providers, and leadership.
• Monitor RADV compliance and track audit results, trends, and performance metrics.
• Collaborate with coding staff, providers, and operations to improve documentation quality and coding accuracy.
• Assist with education on risk adjustment and documentation best practices.
• Maintain HIPAA confidentiality and comply with regulations.
• Meet daily and weekly productivity and quality targets.

Skills

CMS-HCC risk adjustment

ICD-10-CM guidelines

RADV requirements

Attention to detail

Analytical thinking

Communication skills

Independent work

Organizational skills

Education

Certified Professional Coder (CPC)

Certified Risk Adjustment Coder (CRC)

Certified Coding Specialist (CCS)

Bachelor’s degree in Health Information Management

Tools

EMR systems

Microsoft Excel

Job description

CommUnityCare is seeking a Risk Adjustment Auditor to review medical records and documentation for accurate diagnosis capture in line with CMS risk adjustment guidelines and ICD-10-CM standards.

The role involves bi-directional reviews, identifying coding gaps, and collaborating with coding teams and clinicians to enhance documentation quality and compliance. Requires CPC/CRC/CCS or equivalent and at least two years of experience.