Senior Risk Adjustment Auditor

HonestHealth, Inc

Risk Adjustment Auditor ensuring coding accuracy for healthcare at Honest Health. Collaborating with internal teams and vendors to improve documentation practices and compliance standards.

Posted 6/26/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $37 - $43 per hourWebsite

About the role

Key responsibilities & impact

Audit third-party vendor coding and CDI outputs to ensure accuracy, compliance, and adherence to contracted performance standards
Audit internal CDI Specialist I and II work, including chart reviews, queries, and reconciliation activities
Identify coding inaccuracies, unsupported diagnoses, missed HCC opportunities, and documentation gaps
Deliver audit findings, trend analysis, and corrective action recommendations to CDI leadership and vendor partners
Track and report audit performance metrics to support continuous quality improvement initiatives.
Review completed encounters in the post-visit, pre-billing window to validate documentation completeness and coding accuracy
Review and audit Pre-visit plan coding and CDI
Evaluate alignment between medical record documentation and draft claims, ensuring proper HCC capture
Assess each diagnosis for appropriate ICD-10-CM specificity and MEAT criteria compliance
Prioritize high-impact conditions and risk-adjustable diagnoses for intervention and resolution
Ensure compliant query practices aligned with AHIMA and ACDIS standards
Review query quality, provider responses, and documentation updates to confirm clinical support for diagnoses
Validate final alignment between documentation and submitted claims, resolving discrepancies in partnership with coding and billing teams
Translate audit findings into targeted provider and team education on documentation, coding specificity, and risk adjustment compliance
Partner with CDI, coding, and leadership teams to improve workflows, policies, and audit readiness
Serve as a subject matter expert and resource on risk adjustment, CDI best practices, and audit standards
Support the evolution of CDI and audit processes as automation, EMR integrations, and vendor models mature
Identify opportunities to expand audit scope (e.g., documentation patterns, provider performance trends, process inefficiencies)
Contribute to the development of scalable audit frameworks and quality assurance methodologies
Deliver real-time and aggregate coding and documentation feedback to providers and their clinical support teams
Design and facilitate education sessions on ICD-10-CM specificity, chronic condition documentation, HCC coding, and risk adjustment compliance both virtually and, on occasion, in person
Perform other related responsibilities as assigned

Requirements

What you’ll need

Associate’s or Bachelor’s degree in Health Information Management, Nursing, or a related clinical field (or equivalent experience)
5+ years of experience in risk adjustment, medical coding, CDI, or auditing
2+ years of experience in prospective and concurrent review risk adjustment coding and auditing
Direct experience with Medicare Advantage (Part C) risk adjustment models and HCC coding required
Experience auditing vendor-delivered work and/or CDI programs preferred
One or more of the following certifications: CRC (Certified Risk Adjustment Coder) and CPC (Certified Professional Coder) are required
CCS (Certified Coding Specialist) or CCDS (Certified Clinical Documentation Specialist) is preferred
RHIT/RHIA is preferred
Advanced knowledge of ICD-10-CM Official Guidelines and AHA Coding Clinic guidance
Advanced technical expertise in risk adjustment and coding compliance
Strong understanding of CMS risk adjustment methodologies and HCC models
Expertise in MEAT criteria application and compliant query practices
Familiarity with CDI workflows, EMR systems, and coding/audit tools
Strong analytical skills with the ability to identify patterns, risks, and improvement opportunities
High attention to detail and commitment to accuracy and compliance
Ability to collaborate effectively across CDI, coding, vendor management, and provider teams
Ability to translate complex audit findings into clear, actionable insights
Effective communication and collaboration skills across clinical and non-clinical stakeholders
Ability to manage multiple priorities in a fast-paced, evolving environment
Ability to work independently in a remote environment
Willingness to travel up to 25% for provider education or team collaboration
Commitment to maintaining confidentiality and compliance with all regulatory requirements.

Benefits

Comp & perks

Eligible for short-term incentives
Comprehensive benefits package

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

ICD-10-CMrisk adjustment codingHCC codingauditingchart reviewsdocumentation validationtrend analysiscoding compliancequery practicesquality assurance methodologies

Soft Skills

analytical skillsattention to detailcollaborationcommunication skillsability to manage prioritiesindependenceeducational facilitationactionable insights translationcommitment to complianceproblem-solving

Certifications

CRCCPCCCSCCDSRHITRHIA