Risk Adjustment Auditor: Precision Coding & Compliance

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 60,000 - 85,000; Full time

Job summary

CommunityCare HMO Inc. seeks a Risk Adjustment Auditor to review medical records and ensure accurate diagnoses are captured according to CMS risk adjustment guidelines and ICD-10-CM coding standards.

The role supports accurate risk score calculation, regulatory compliance, and program integrity within the organization. Responsibilities include bi-directional reviews, identifying coding gaps, reporting findings, and training staff while upholding HIPAA requirements and meeting productivity

Qualifications

• Two years of risk adjustment coding or auditing experience.
• Experience reviewing medical records across multiple specialties.
• Certified Professional Coder (CPC), CRC, CCS, or equivalent coding certification.
• Bachelor’s degree in Health Information Management or related field preferred.

Responsibilities

• Review medical records to validate and capture risk-adjusted diagnoses (HCCs).
• Ensure documentation supports coded conditions per ICD-10-CM and CMS guidelines.
• Identify unsupported diagnoses, over- or under-coding, and gaps.
• Provide audit findings and recommendations to coding teams and leadership.
• Monitor RADV standards and report audit results and trends.
• Collaborate with providers and staff to improve documentation quality.
• Assist with education and training on risk adjustment best practices.
• Maintain HIPAA confidentiality and meet productivity goals.

Skills

CMS-HCC knowledge

HHS-HCC knowledge

ICD-10-CM coding

RADV requirements

EMR systems

Microsoft Office

Attention to detail

Analytical thinking

Verbal & written communication

Independent work

Organization

Integrity/compliance

Education

Bachelor’s degree in Health Information Management or related field

CPC/CRC/CCS or equivalent coding certification

Two years of risk adjustment coding or auditing experience

Experience with Medicare Advantage / ACA audits

Tools

EMR systems

Microsoft Office (Excel)

Job description

CommunityCare HMO Inc. seeks a Risk Adjustment Auditor to review medical records and ensure accurate diagnoses are captured according to CMS risk adjustment guidelines and ICD-10-CM coding standards.

The role supports accurate risk score calculation, regulatory compliance, and program integrity within the organization. Responsibilities include bi-directional reviews, identifying coding gaps, reporting findings, and training staff while upholding HIPAA requirements and meeting productivity