Senior Medicare Risk Adjustment Auditor

Tecsa; Illinois; On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical, Dental, and Vision

401(K) match up to 4%

Paid Time Off

Employee Assistance Programs

Paid Maternal Leave

Paid Paternal Leave

Job summary

Zing Health is hiring a Senior Risk Adjustment Coding Auditor to ensure compliant, accurate coding across Medicare Advantage programs. You will lead coding audits, support CMS RADV reviews, and partner with vendors to improve quality and compliance.

The role requires expertise in ICD-10-CM, CMS-HCC methodologies, and RADV requirements, with a focus on accuracy, regulatory adherence, and continuous improvement in a fast-paced environment.

Qualifications

• Minimum of 5 years of Medicare Advantage Risk Adjustment coding and auditing experience.
• Active coding certification required; CRC strongly preferred.
• Advanced knowledge of CMS-HCC risk adjustment, ICD-10-CM guidelines, and RADV requirements.
• Experience auditing coding vendors and risk adjustment submissions, with QA & coding validation.
• Strong analytical, organizational, and communication skills.

Responsibilities

• Review, validate, and code Medicare Advantage records using ICD-10-CM and CMS-HCC methodologies to support accurate risk adjustment submissions.
• Conduct quality assurance audits to ensure coding accuracy and documentation integrity across vendors and programs.
• Support RADV audits and regulatory reviews, including chart review and audit readiness activities.
• Monitor coding quality and vendor performance to identify risks and opportunities for improvement.
• Lead quality improvement initiatives and provide actionable recommendations to leadership.

Skills

Analytical skills

Problem-solving

Communication skills

Independent work

Multitasking

Education

Bachelor's degree

Tools

Excel

Audit tools

Job description

Zing Health is hiring a Senior Risk Adjustment Coding Auditor to ensure compliant, accurate coding across Medicare Advantage programs. You will lead coding audits, support CMS RADV reviews, and partner with vendors to improve quality and compliance.

The role requires expertise in ICD-10-CM, CMS-HCC methodologies, and RADV requirements, with a focus on accuracy, regulatory adherence, and continuous improvement in a fast-paced environment.