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Coding Audit Specialist, Health Plan
Sanford HealthCoding audit specialist reviewing health-plan medical records for Sanford Health, a rural nonprofit health system. Ensuring accurate risk-adjustment coding across Medicare Advantage, ACA/Exchange, and Medicaid programs.
Posted 8/18/2026full-timeRemote • South Dakota, Wisconsin • 🇺🇸 United StatesMid-LevelSenior💰 $22 - $35 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in coding accuracy and compliance through thorough auditing and quality assurance processes, with a strong understanding of CMS guidelines and medical coding standards. Capable of analyzing data and presenting findings to improve risk adjustment documentation and coding practices.
Highest-signal resume keywords
ICD-9 CodingICD-10 CodingCPT CodingHCC CodingCertified Professional Coder
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical TerminologyAnatomyQuality AssuranceCoding AnalysisAudit Documentation
Tools & Technologies
WordExcelAccess
Certifications & Qualifications
Certified Professional CoderCertified Risk Adjustment Coder
Industry Keywords
CMS GuidelinesMedicare AdvantageHHS-ACADHS/BadgerCare PlusCurrent Procedural Terminology
About the role
Key responsibilities & impact- Conduct quality assurance activities to ensure the accuracy and integrity of risk adjustment data submitted to CMS and DHS
- Identify coding deficiencies and provide management with analysis of outcomes and tools to improve coding accuracy
- Develop, implement, and monitor a continuous monitoring program for Medicare Advantage, ACA/Exchange, and Medicaid/BadgerCare Plus diagnosis documentation
- Audit medical record documentation to identify uncoded or miscoded diagnoses
- Audit coding for visits and procedures across specialties and subspecialties as related to HCC coding
- Maintain knowledge of coding rules, codes, documentation guidelines, CMS policies, and reimbursement guidelines
- Compare provider documentation with reported code requirements to verify coding support
- Formulate audit outcomes and present findings in logical, concise summaries
Requirements
What you’ll need- High school diploma or equivalent required
- Demonstrated knowledge of anatomy/physiology and medical terminology
- Completion of courses in Current Procedural Terminology and ICD-9 and ICD-10 coding required
- Three years of experience in a health insurance, compliance, quality assurance, or auditing-related position
- Experience with ICD-9, ICD-10, CPT, HCC, and HCPCS coding
- Knowledge of CMS guidelines affecting Medicare Advantage, HHS-ACA, and DHS/BadgerCare Plus members
- Demonstrated knowledge of Word, Excel, and Access
- Certified Professional Coder and/or Certified Risk Adjustment Coder certification from the American Academy of Professional Coders required within one year of hire
- Associate Degree in coding and/or a health-related field preferred
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Sanford Health Website LinkedIn All Job Openings 10,000+ employees Founded 1894 🛡️ Insurance 🏥 Healthcare ⚕️ Healthcare Insurance Insurance
- Healthcare
- Healthcare Insurance Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine. Coding Audit Specialist, Health Plan Job not on LinkedIn 🔥 1 minute ago 🗿 South Dakota, Wisconsin – Remote 💵 $21 - $34 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior ✨ Coding Specialist 🦅 H1B Visa Sponsor Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- Conduct quality assurance activities to ensure the accuracy and integrity of risk adjustment data submitted to CMS and DHS
- Identify coding deficiencies and provide management with analysis of outcomes and tools to improve coding accuracy
- Develop, implement, and monitor a continuous monitoring program for Medicare Advantage, ACA/Exchange, and Medicaid/BadgerCare Plus diagnosis documentation
- Audit medical record documentation to identify uncoded or miscoded diagnoses
- Audit coding for visits and procedures across specialties and subspecialties as related to HCC coding
- Maintain knowledge of coding rules, codes, documentation guidelines, CMS policies, and reimbursement guidelines
- Compare provider documentation with reported code requirements to verify coding support
- Formulate audit outcomes and present findings in logical, concise summaries 🎯 Requirements
- High school diploma or equivalent required
- Demonstrated knowledge of anatomy/physiology and medical terminology
- Completion of courses in Current Procedural Terminology and ICD-9 and ICD-10 coding required
- Three years of experience in a health insurance, compliance, quality assurance, or auditing-related position
- Experience with ICD-9, ICD-10, CPT, HCC, and HCPCS coding
- Knowledge of CMS guidelines affecting Medicare Advantage, HHS-ACA, and DHS/BadgerCare Plus members
- Demonstrated knowledge of Word, Excel, and Access
- Certified Professional Coder and/or Certified Risk Adjustment Coder certification from the American Academy of Professional Coders required within one year of hire
- Associate Degree in coding and/or a health-related field preferred Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Coding Education Specialist 🕒 Yesterday Boston Medical Center (BMC) 5001 - 10000 Website LinkedIn All Job Openings Coding education specialist developing billing training and auditing medical records for Boston Medical Center. Improving physician documentation, coding accuracy, and revenue-cycle performance through education and chart review. 🇺🇸 United States – Remote 💵 $62.5k - $91k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior ✨ Coding Specialist Coding Education Specialist 🕒 Yesterday Boston Medical Center (BMC) 5001 - 10000 Website LinkedIn All Job Openings Coding Education Specialist developing billing education and training for Boston Medical Center. Auditing charts and advising physicians on medical coding and documentation. 🇺🇸 United States – Remote 💵 $62.5k - $91k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior ✨ Coding Specialist Inpatient Coding Quality Specialist 🕒 5 days ago Mass General Brigham 10,000+ employees 💼 Consulting 🏥 Healthcare 📚 Education Website LinkedIn All Job Openings Inpatient coding quality specialist improving coding accuracy and compliance for Mass General Brigham. Developing QA programs, analyzing records, and training healthcare professionals. 🇺🇸 United States – Remote 💵 $30 - $44 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior ✨ Coding Specialist 🦅 H1B Visa Sponsor Coding Quality Specialist 🕒 August 11 Mass General Brigham 10,000+ employees 💼 Consulting 🏥 Healthcare 📚 Education Website LinkedIn All Job Openings Coding quality specialist improving medical coding accuracy, documentation, and compliance for Mass General Brigham’s healthcare system. Monitoring records, training coding and clinical staff, and reporting quality metrics remotely. 🇺🇸 United States – Remote 💵 $30 - $44 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior ✨ Coding Specialist 🦅 H1B Visa Sponsor Coding Education Specialist – Inpatient Medicine 🕒 August 11 US Acute Care Solutions 1001 - 5000 🏥 Healthcare 💊 Pharmaceuticals 📡 Telecommunications Website LinkedIn All Job Openings Coding Education Specialist developing inpatient medicine coding curricula for USACS, a hospital-based emergency and inpatient medicine provider. Analyzing coding issues, audits, and learner performance while training internal and vendor coders. 🇺🇸 United States – Remote 💵 $24 - $45 / hour 💰 Private Equity Round on 2021-02 ⏰ Full Time 🟡 Mid-level 🟠 Senior ✨ Coding Specialist 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates About us Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass Resume Review AI Apply Copilot OpenClaw job finder Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs