Risk Adjustment Auditor II

Risk Adjustment Auditor II – Hybrid schedule within Oregon, Idaho, Utah or Washington. Join the Risk Adjustment team at Cambia Health Solutions, a purpose‑driven company dedicated to improving health care.

As a Risk Adjustment Auditor II you will perform retrospective and prospective chart reviews to ensure accurate risk adjustment reporting, identify coding trends, partner with provider education consultants, and actively participate in quality improvement initiatives.

• Perform retrospective and prospective chart reviews for accurate risk adjustment reporting
• Verify and ensure the accuracy, completeness, specificity, and appropriateness of provider‑reported diagnosis codes based on medical record documentation
• Review medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories
• Identify trends in provider coding and documentation and partner with Provider Education Consultants to develop intervention strategies
• Support and actively participate in process and quality improvement initiatives
• Maintain knowledge of relevant regulatory mandates and ensure activities are in compliance with requirements
• Consistently meet departmental performance and attendance requirements
• Serve as a mentor to Risk Adjustment Auditor I staff
• Assist with special projects such as risk mitigation reviews
• Serve as subject‑matter resource regarding risk adjustment processes and diagnosis coding
• Monitor and interpret regulatory changes that may impact the Risk Adjustment Program and assist with implementation activities

Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or an equivalent combination of education and experience.

• Required:
  
  Coding Certification (CCA, CCS, CCS‑P, CPC, or CPC‑P)
• Preferred: RADV, Risk Adjustment, HCC or inpatient coding experience
• Demonstrated ability to perform accurate and complete chart reviews for risk adjustment
• Knowledge of Official ICD‑9‑CM/ICD‑10 coding guidelines
• Analytical ability to identify problems, develop solutions, and implement actions promptly
• Proficient PC skills with Word, Excel and Outlook
• Effective verbal and written communication skills
• Knowledge of health systems operations and reimbursement methodologies
• Advanced knowledge of risk adjustment, coding and documentation requirements
• Ability to provide proactive and creative solutions to business problems

• Work primarily performed in office or remote environment
• Travel may be required, locally or out of state
• May require overtime and work outside normal hours

The expected hiring range for a Risk Adjustment Auditor II is $68,900.00 – $93,150.00 depending on skills, experience, education, and training. Bonus target is 10%. The full salary range for this role is $64,000.00 to $.

We are an Equal Opportunity employer dedicated to a drug and tobacco‑free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status, or any other status protected by law. A background check is required.

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