Risk Adjustment Coding Auditor

Location:

Remote

Job Type: Contract (6 months)

Compensation: $35.00 – $38.00 per hour

Industry: Health Insurance

Our firm is partnering with a leading nonprofit health insurance organization that serves members across commercial, Medicare, and Medicaid health plans. We are seeking an experienced Risk Adjustment Coding Auditor to help ensure the accuracy, integrity, and compliance of clinical coding and documentation used in risk adjustment programs. In this role, you will support accurate reimbursement and regulatory compliance by conducting detailed coding audits, identifying documentation gaps, and providing expert guidance on risk adjustment coding practices.

This position is ideal for a coding professional with strong HCC auditing experience who is passionate about data accuracy, compliance, and continuous improvement.

As a Risk Adjustment Coding Auditor, you will evaluate coded clinical data to ensure compliance with risk adjustment regulations, coding guidelines, and industry best practices. You will work closely with internal stakeholders to improve coding accuracy, support audit initiatives, and mitigate financial and regulatory risk.

• Perform retrospective and prospective medical record reviews to validate risk adjustment coding accuracy.
• Audit provider-reported diagnosis codes for accuracy, completeness, specificity, and appropriate documentation support.
• Review medical records to identify opportunities for complete and accurate CMS-HCC diagnosis code capture.
• Evaluate risk adjustment coding practices for consistency and compliance with applicable coding standards.
• Ensure compliance with HIPAA, privacy, security, and regulatory requirements when handling patient information.
• Monitor and apply current risk adjustment regulations, coding guidelines, and industry requirements.
• Provide written and verbal feedback regarding coding errors, trends, and improvement opportunities.
• Serve as a subject matter expert on risk adjustment coding processes and diagnosis coding methodologies.
• Support audit production goals and meet established turnaround times and deliverables.
• Participate in special projects, including risk mitigation reviews and other compliance-related initiatives.
• Collaborate with business partners to improve coding quality and documentation practices.

• 7+ years of relevant professional experience, including applicable work experience, education, transferable skills, or military experience.
• 5+ years of HCC coding experience utilizing both inpatient and outpatient coding guidelines.
• 5+ years of experience auditing risk adjustment records.
• 1+ year of experience working in a production-driven environment.
• Certified Risk Coder (CRC) credential in good standing, or the ability to obtain certification within six months of hire/conversion in addition to any required coding certification.
• Working knowledge of Medicare, ACA Commercial, and Medicaid risk adjustment models.
• Demonstrated ability to interpret and apply coding policies using strong analytical and critical thinking skills.
• Experience providing written and verbal guidance related to coding errors, trends, and compliance findings.
• Intermediate or higher proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.
• Strong organizational skills with the ability to manage multiple priorities in a deadline-driven environment.
• High school diploma or equivalent.

• Bachelor's degree in a related field.
• HEDIS and/or STARS program experience.
• Provider education or training experience.
• Risk Adjustment Data Validation (RADV) experience.
• Certified Professional Medical Auditor (CPMA) or additional coding certifications.
• Experience supporting large health plan, managed care, or payer organizations.

Benefits Dahl Consulting is proud to offer a comprehensive benefits package to eligible employees that will allow you to choose the best coverage to meet your family’s needs. For details, please review the DAHL Benefits

Summary:

As an equal opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you!