Risk Adjustment Coding Auditor

We are seeking an experienced Risk Adjustment Coding Auditor to join our team. This role is responsible for ensuring the accuracy, completeness, and compliance of risk adjustment coding and clinical documentation across Medicare, Medicaid, and ACA Commercial populations. The ideal candidate will bring deep expertise in HCC coding, risk adjustment auditing, and regulatory compliance while serving as a trusted resource for coding guidance and best practices.

• Conduct retrospective and prospective chart reviews to validate risk adjustment diagnoses and reporting accuracy.
• Audit provider-reported diagnosis codes for accuracy, specificity, completeness, and documentation support.
• Review medical records to identify complete and accurate diagnosis capture in alignment with CMS-HCC guidelines.
• Ensure coding practices comply with applicable regulatory requirements, coding standards, and organizational policies.
• Maintain compliance with HIPAA, privacy, security, and confidentiality requirements when handling patient information.
• Identify coding discrepancies, documentation gaps, and trends that may impact risk adjustment performance.
• Provide written and verbal feedback regarding coding errors, audit findings, and process improvement opportunities.
• Support organizational audit and production goals while meeting established deadlines and productivity standards.
• Assist with risk mitigation reviews, special projects, and supplemental audit initiatives.
• Serve as a subject matter expert on risk adjustment methodologies, diagnosis coding, and regulatory requirements.
• Collaborate with internal stakeholders to improve coding accuracy and documentation practices.

• High School Diploma or equivalent.
• Legal authorization to work in the United States.
• CRC (Certified Risk Coder) certification in good standing.
• 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-driven environment.
• Intermediate knowledge of Medicare, Medicaid, and ACA Commercial risk adjustment models.
• Demonstrated ability to interpret and apply coding policies using sound critical thinking and analytical skills.
• Experience providing written and verbal education on coding errors, trends, and best practices.
• Intermediate proficiency with Microsoft Office Suite (Excel, Word, Outlook, and PowerPoint).
• Strong organizational, time management, and multitasking skills with the ability to meet deadlines.

• Bachelor's degree.
• RHIT or RHIA credential combined with strong risk adjustment coding experience.
• HEDIS and/or STARS program experience.
• Provider education and training experience.
• Prior RADV audit experience.
• CPMA or additional coding certifications.
• Experience utilizing NLP (Natural Language Processing) software solutions.
• Advanced knowledge of risk adjustment methodologies and compliance standards.

This is a Contract position based out of Minneapolis, MN.

The pay range for this position is $32.00 - $37.00/hr.

• 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)

This position is anticipated to close on Nov 6, 2026.

This is a fully remote position.

The company is an equal opportunity employer and will consider all applications without…