Risk Adjustment Coding Auditor

Risk Adjustment Coding Auditor

Overview

We are seeking a detail-oriented Risk Adjustment Coding Auditor to support the accuracy, integrity, and compliance of clinical coding data across risk adjustment programs. In this role, you will conduct audits, review medical record documentation, identify coding opportunities, and provide guidance on coding accuracy to help support compliant reporting and appropriate reimbursement.
The ideal candidate will bring extensive HCC coding and risk adjustment auditing experience, strong analytical skills, and a thorough understanding of Medicare, Medicaid, and ACA risk adjustment models.

Key Responsibilities

• Perform retrospective and prospective chart reviews to evaluate risk adjustment diagnosis coding accuracy.
• Audit medical records to verify the completeness, specificity, and appropriateness of reported diagnoses.
• Review clinical documentation to ensure accurate HCC capture and risk adjustment reporting.
• Evaluate coding practices for compliance with CMS guidelines, industry standards, and organizational policies.
• Identify coding discrepancies, documentation gaps, and opportunities for improvement.
• Provide written and verbal feedback regarding coding errors, trends, and audit findings.
• Serve as a subject matter resource for risk adjustment coding and audit processes.
• Support audit production goals and meet established turnaround times and deadlines.
• Participate in risk mitigation reviews and special projects as assigned.
• Maintain compliance with HIPAA, privacy, security, and regulatory requirements.
• Stay current on coding regulations, risk adjustment methodologies, and industry updates.

Required Qualifications

• 7+ years of related professional experience.
• 5+ years of HCC coding experience utilizing inpatient and outpatient coding guidelines.
• 5+ years of experience auditing risk adjustment records.
• 1+ year of experience working in a production-based environment.
• CRC (Certified Risk Coder) certification in good standing.
• Knowledge of Medicare, Medicaid, and ACA Commercial risk adjustment models.
• Ability to interpret and apply coding policies, regulations, and guidelines.
• Experience providing coding education, audit feedback, and trend analysis.
• Intermediate proficiency with Microsoft Office Suite (Excel, Word, PowerPoint, and Outlook).
• Strong organizational, analytical, and time management skills.
• Ability to manage multiple priorities in a deadline-driven environment.
• High school diploma or equivalent.

Preferred Qualifications

• Bachelor's degree.
• HEDIS and/or STARS experience.
• Provider education experience.
• Risk Adjustment Data Validation (RADV) experience.
• CPMA or additional coding credentials.
• Experience with NLP (Natural Language Processing) software.
• RHIT or RHIA certification combined with strong risk adjustment coding experience.

Skills

• Risk Adjustment Auditing
• HCC Coding
• ICD-10-CM Coding
• Risk Adjustment Programs
• Medicare Advantage
• Medicaid
• ACA Commercial Plans
• Clinical Documentation Review
• Healthcare Compliance
• Medical Record Auditing
• Coding Education & Feedback
• Quality Assurance
• HIPAA Compliance
• Data Integrity
• Microsoft Office Suite

What Makes You Successful

• Strong attention to detail and commitment to coding accuracy.
• Excellent critical thinking and problem-solving abilities.
• Effective written and verbal communication skills.
• Ability to work independently while collaborating with cross-functional teams.
• Commitment to maintaining compliance and high-quality audit standards.

Job Type & Location
This is a Contract position based out of Phoenix, AZ.
Pay and Benefits
The pay range for this position is $32.00 - $37.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Final date to receive applications
This position is anticipated to close on Aug 4, 2026.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change.

That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color,…