Risk Adjustment - Risk Adjustment Coding Auditor 135-2014

DaMar Staffing; Tulsa (OK); On-site; USD 60,000 - 85,000; Full time

Job summary

DaMar Staffing seeks a Risk Adjustment Auditor in Tulsa, OK to review medical records and ensure accurate capture of diagnoses in line with CMS risk adjustment guidelines and ICD-10-CM standards.

You will perform bidirectional chart reviews, identify coding gaps, and provide actionable recommendations to coding teams and leadership to support accurate risk scores and program integrity.

Qualifications

• Two years or more risk adjustment coding or auditing experience.
• Experience reviewing medical records across specialties.
• Certified Professional Coder (CPC), CRC, CCS or equivalent.

Responsibilities

• Perform retrospective and prospective medical record reviews to validate risk adjusted diagnoses.
• Ensure documentation supports coded conditions per ICD-10-CM and payer guidelines.
• Identify unsupported diagnoses, over/under-coding, and documentation gaps.
• Provide audit findings and recommendations to teams and leadership.
• Monitor RADV standards and report trends and performance metrics.
• Collaborate to improve documentation quality and coding accuracy.
• Assist with education and training on risk adjustment best practices.
• Maintain HIPAA confidentiality and compliance.

Skills

CMS-HCC knowledge

HCC risk adjustment knowledge

ICD-10-CM guidelines

RADV requirements

EMR systems

Microsoft Office (Excel)

attention to detail

analytical thinking

communication

independence

deadline mindset

Education

Health Information Management degree or related field

CPC/CRC/CCS or equivalent certification

Bachelor’s degree preferred

Tools

EMR systems

Microsoft Office

Job description

JOB SUMMARY:

The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity.

KEY RESPONSIBILITIES:

• Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements.
• Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines.
• Identify unsupported diagnoses, over coding, under-coding, and documentation gaps.
• Provide detailed audit findings and recommendations to coding teams, providers, and leadership.
• Monitor compliance with CMS Risk Adjustment Data Validation (RADV) standards.
• Track and report audit results, trends, and performance metrics.
• Collaborate with coding staff, providers, and operations teams to improve documentation quality and coding accuracy.
• Assist with education and training initiatives related to risk adjustment and documentation best practices.
• Maintain confidentiality and ensure compliance with HIPAA regulations.
• Meet daily and weekly productivity goals and quality standards set by the supervisor.
• Perform other job-related duties as required or assigned.

QUALIFICATIONS:

• Knowledge of CMS-HCC and HHS-HCC risk adjustment model.
• Knowledge of ICD-10-CM coding guidelines.
• Knowledge of RADV requirements.
• Proficiency in EMR systems and Microsoft Office (Excel preferred).
• High attention to detail.
• Strong analytical and critical thinking skills.
• Clear written and verbal communication.
• Ability to work independently and meet deadlines.
• Strong organizational skills.
• Integrity and commitment to compliance.
• Successful completion of Health Care Sanctions background check.

EDUCATION/EXPERIENCE:

• A minimum of 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.
• Experience with internal audit programs or payer audits preferred.