Risk Adjustment Auditor II

Apply for the Risk Adjustment Auditor II role at Cambia Health Solutions
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Work a hybrid schedule within Oregon, Idaho, Utah or Washington.

Every day, Cambia’s dedicated team of Risk Adjustment Auditors lives our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Auditors perform retrospective and prospective chart reviews both on and off‑site using various types of records to ensure accurate risk adjustment reporting. They also identify trends in provider coding/documentation and work closely with Provider Education Consultants to develop intervention strategies, all in service of making our members’ health journeys easier.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing (or equivalent combination of education and experience). Coding certification (CCA, CCS, CCS‑P, CPC, or CPC‑P) required. RADV, Risk Adjustment, HCC or inpatient coding experience preferred.

• Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.
• Knowledge of and adherence to Official ICD‑9‑CM/ICD‑10 Coding Guidelines.
• Analytical ability to identify problems, develop solutions, and implement actions in a timely manner.
• Ability to identify and communicate trends in provider coding and documentation.
• Proficient PC skills and familiarity with corporate software such as Word, Excel and Outlook.
• Effective verbal and written communication skills.
• Knowledge of health systems operations, reimbursement methodologies and coding conventions for governmental and commercial products.
• Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.
• Proactive and creative problem‑solving skills.

• Perform retrospective and prospective chart reviews to ensure 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 comply 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 the risk adjustment process and diagnosis coding.
• Monitor and interpret regulatory changes that may impact the administration of the Risk Adjustment Program; assist with implementation activities as a result.

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

The hiring range is $68,900.00 – $93,150.00, depending on skills, experience, education, training, licensure/certifications, performance history and work location. The bonus target is 10%. Current full salary range is $64,000.00 – $.

Working at Cambia means being part of a purpose‑driven, award‑winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person‑focused health care.

• Work alongside diverse teams building cutting‑edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in…