Risk Adjustment Auditor: Precision in Coding & Compliance

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

Job summary

CommunityCare HMO Inc. is seeking a Risk Adjustment Auditor to review medical records, validate diagnoses, and ensure coding accuracy per CMS guidelines. You will identify gaps, provide actionable findings, and support education across coding teams.

Strong attention to detail and knowledge of RADV requirements are essential. The role requires two years of risk adjustment coding or auditing experience, CPC/CRC/CCS credentials, and proficiency with EMR systems and Excel.

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.
• Previous auditing experience in Medicare Advantage and ACA preferred.

Responsibilities

• Review medical records and documentation to validate risk-adjusted diagnoses per CMS guidelines.
• Identify unsupported diagnoses, over-coding, under-coding, and documentation gaps.
• Provide detailed audit findings and recommendations to coding teams, providers, and leadership.
• Monitor RADV compliance and report trends and performance metrics.
• Collaborate with coding staff, providers, and operations to improve documentation quality and accuracy.
• Assist with education and training initiatives related to risk adjustment and documentation best practices.
• Maintain confidentiality and ensure HIPAA compliance.
• Meet daily and weekly productivity and quality standards set by the supervisor.
• Perform other job-related duties as required or assigned.

Skills

CMS-HCC knowledge

ICD-10-CM guidelines

RADV requirements

EMR systems

Microsoft Excel

Detail oriented

Communication

Independent work

Analytical thinking

Education

Bachelors in HIM

CPC/CRC/CCS

Tools

EMR systems

Microsoft Excel

Job description

CommunityCare HMO Inc. is seeking a Risk Adjustment Auditor to review medical records, validate diagnoses, and ensure coding accuracy per CMS guidelines. You will identify gaps, provide actionable findings, and support education across coding teams.

Strong attention to detail and knowledge of RADV requirements are essential. The role requires two years of risk adjustment coding or auditing experience, CPC/CRC/CCS credentials, and proficiency with EMR systems and Excel.