Senior Risk Adjustment Auditor II | Hybrid

Cambia Health Solutions, Inc.; Salt Lake City (UT); Hybrid; USD 58,000 - 94,000; Full time

Job summary

Cambia Health Solutions, Inc. is seeking a Risk Adjustment Auditor I or II for a hybrid role with in-office work three days per week in Salt Lake City, UT. The role includes retrospective and prospective chart reviews to ensure accurate risk adjustment reporting.

Ideal candidates hold an Associate degree in healthcare and 1–3 years of coding/auditing experience, with CPC/CRC certifications preferred. Proficiency in Word, Excel and Outlook, plus strong analytical and communication skills, are

Qualifications

• Associate degree in Healthcare or related field and 1 year of clinical coding or auditing experience.
• Risk Adjustment, HCC or Inpatient coding experience required.
• CPC and CRC coding certifications preferred.

Responsibilities

• Performs retrospective and prospective chart reviews to ensure accurate risk adjustment reporting.
• Performs quality reviews of vendor coding in support of the risk adjustment process.
• Verifies accuracy and completeness of provider-reported diagnosis codes based on medical records.
• Reviews medical record information to identify complete and accurate diagnosis code capture per CMS HCC/HHS HCC.
• Identifies trends in provider/vendor coding and collaborates with leadership to develop interventions.
• Supports process and quality improvement initiatives and regulatory compliance.
• Maintains knowledge of regulatory mandates affecting risk adjustment program.
• Mentors junior staff and participates in special projects as needed.

Skills

Chart reviews

Quality audits

ICD-9/ICD-10 coding

Analytical skills

Trends in coding

PC productivity tools

Communication skills

AI tools experience

Education

Associate degree in Healthcare or related field

Tools

Word

Excel

Outlook

Job description

Cambia Health Solutions, Inc. is seeking a Risk Adjustment Auditor I or II for a hybrid role with in-office work three days per week in Salt Lake City, UT. The role includes retrospective and prospective chart reviews to ensure accurate risk adjustment reporting.

Ideal candidates hold an Associate degree in healthcare and 1–3 years of coding/auditing experience, with CPC/CRC certifications preferred. Proficiency in Word, Excel and Outlook, plus strong analytical and communication skills, are