Risk Adjustment Auditor

The Associate, Risk Adjustment Auditor is responsible for conducting internal and external quality audits focused on ICD-10 code abstraction accuracy, completeness, and clinical documentation improvement opportunities. They collaborate with management to establish benchmarks, acceptable thresholds, and quality assurance programs to ensure compliance with coding standards and risk adjustment practices. Key duties include performing medical record reviews, validating encounter data, monitoring risk adjustment coding performance, and conducting CMS audits. The role involves developing provider education resources, implementing process improvements to maximize risk adjustment factors, and maintaining adherence to relevant laws and regulations. Qualifications include a bachelor's degree or equivalent experience, a Certified Professional Coder (CPC), and 3+ years of retrospective risk adjustment coding experience, along with 1+ year of quality auditing or RADV experience. Preferred qualifications include certification as a Risk Adjustment Coder (CRC) and experience with various EMR systems. Skills involve strong knowledge of ICD-10-CM guidelines, audit techniques, and risk adjustment processes. This remote position offers competitive salary, benefits, and opportunities for professional growth.