Risk Adjustment Coding Auditor

The Judge Group; United States; Remote; USD 85,000 - 125,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Job summary

The Judge Group is seeking a Risk Adjustment Coding Auditor for a 5+ month contract to ensure the accuracy, completeness, and compliance of coded clinical data supporting risk adjustment programs and reimbursement. You will conduct chart reviews, identify documentation gaps, and help optimize CMS HCC capture while providing actionable feedback.

Candidates should have 7+ years in risk adjustment, medical coding, or auditing, with CRC or CPMA credentials, strong Microsoft Office skills, and the

Qualifications

• High school diploma or equivalent practical experience (required).
• 7+ years in risk adjustment, medical coding, auditing, or related healthcare field.
• 5+ years of HCC coding experience with inpatient/outpatient guidelines.
• 5+ years auditing Risk Adjustment records.
• 1+ year in a production-based environment.
• CRC certification and an additional coding credential, or ability to obtain within six months.
• Experience with Medicare, ACA Commercial, and Medicaid risk adjustment models.
• Experience interpreting coding policies, regulations, and documentation standards.
• Experience providing written and verbal feedback on coding errors and trends.
• Proficiency with Microsoft Office Suite and Teams.
• Ability to manage multiple priorities in a deadline-driven environment.
• Authorization to work in the United States without sponsorship.

Responsibilities

• Conduct retrospective and prospective chart reviews to validate risk adjustment coding accuracy and completeness.
• Audit provider-reported diagnosis codes for compliance with guidelines and documentation standards.
• Review medical records to ensure CMS HCC capture is complete and accurate.
• Evaluate coding activities for consistency, accuracy, and adherence to standards.
• Provide written and verbal feedback on deficiencies and opportunities for improvement.
• Ensure HIPAA, privacy, security, and regulatory compliance in handling records.
• Maintain up-to-date knowledge of risk adjustment regulations and coding practices.
• Support audit production goals and deadlines while meeting quality metrics.
• Assist with special projects and risk mitigation initiatives.
• Serve as a subject matter expert on risk adjustment coding processes.
• Partner with providers and internal teams to improve coding accuracy and documentation quality.
• Track, document, and report audit findings and trends.

Skills

Risk adjustment

Medical coding

Auditing

HCC coding

Regulatory knowledge

Communication

Time management

Attention to detail

Education

Bachelor's degree in Health Information Management

Bachelor's degree in Nursing

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Teams

Job description

Risk Adjustment Coding Auditor5+ month ContractMinimum Qualifications

• High school diploma, GED, or equivalent practical experience.
• 7+ years of professional experience in risk adjustment, medical coding, auditing, or a related healthcare field.
• 5+ years of Hierarchical Condition Category (HCC) coding experience utilizing inpatient and outpatient coding guidelines.
• 5+ years of experience auditing Risk Adjustment records.
• 1+ year of experience working in a production-based environment.
• Certified Risk Coder (CRC) certification in good standing and an additional coding certification, or ability to obtain certification within six months of hire.
• Experience with Medicare, ACA Commercial, and Medicaid risk adjustment models.
• Experience interpreting and applying coding policies, regulations, and documentation standards.
• Experience providing written and verbal feedback on coding errors and trends.
• Intermediate proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and Microsoft 365 tools, including Teams.
• Ability to manage multiple priorities in a deadline-driven environment.
• Authorization to work in the United States without sponsorship.

Preferred Qualifications

• Bachelor's degree in Health Information Management, Nursing, Healthcare Administration, or a related field.
• HEDIS and STARS experience.
• Provider education and training experience.
• Risk Adjustment Data Validation (RADV) experience.
• Certified Professional Medical Auditor (CPMA) or additional coding credentials.
• Experience serving as a subject matter expert for risk adjustment programs and diagnosis coding.

About the Job

The Risk Adjustment Coding Auditor ensures the accuracy, completeness, and compliance of coded clinical data to support risk adjustment programs and appropriate reimbursement. This role evaluates coding accuracy, identifies documentation and coding gaps, mitigates regulatory and financial risk, and provides expertise on risk adjustment methodologies. The auditor collaborates with internal stakeholders to improve data integrity and support organizational performance.

Responsibilities

• Conduct retrospective and prospective chart reviews to validate risk adjustment coding accuracy and completeness.
• Audit provider-reported diagnosis codes to ensure compliance with coding guidelines, regulatory requirements, and documentation standards.
• Review medical records to identify opportunities for complete and accurate CMS HCC diagnosis code capture.
• Evaluate risk adjustment coding activities for consistency, accuracy, and adherence to established coding standards and best practices.
• Identify coding and documentation deficiencies and provide written and verbal feedback to stakeholders.
• Ensure compliance with HIPAA, privacy, security, and regulatory requirements while handling patient records and audit data.
• Maintain current knowledge of risk adjustment regulations, coding guidelines, and industry standards.
• Support audit production goals and workload priorities while meeting established quality and timeliness metrics.
• Assist with special projects, including risk mitigation reviews and compliance initiatives.
• Serve as a subject matter expert on risk adjustment coding processes, documentation requirements, and diagnosis coding practices.
• Partner with providers and internal teams to improve coding accuracy and documentation quality.
• Track, document, and report audit findings, trends, and opportunities for process improvement.

Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements.