Coding Audit Specialist, Health Plan

Sanford Health

Coding Audit Specialist reviewing risk-adjustment documentation and diagnoses for Sanford Health’s rural healthcare system. Ensuring CMS, DHS, and payer coding accuracy across Medicare Advantage, ACA, and Medicaid populations.

Posted 8/18/2026full-timeRemote • South Dakota, Wisconsin • 🇺🇸 United StatesMid-LevelSenior💰 $22 - $35 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Expertise in coding accuracy and compliance, with a strong focus on auditing and quality assurance in healthcare settings. Proficient in ICD-9, ICD-10, CPT, and HCPCS coding, along with a solid understanding of CMS guidelines and risk adjustment data management.

Highest-signal resume keywords

ICD-10 CodingCPT CodingQuality AssuranceCertified Professional CoderRisk Adjustment Data Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-9 CodingCPT CodingHCPCS CodingAnatomy KnowledgePhysiology KnowledgeMedical TerminologyCoding AuditingDocumentation GuidelinesCoding Deficiency AnalysisContinuous Monitoring Program Development

Soft Skills

Analytical SkillsCommunication SkillsAttention to DetailProblem-Solving Skills

Tools & Technologies

WordExcelAccess

Certifications & Qualifications

Certified Professional CoderCertified Risk Adjustment Coder

Industry Keywords

CMS GuidelinesMedicare AdvantageHHS-ACADHS/BadgerCare PlusRevenue Management

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 for correct, uncoded, or miscoded diagnoses
Audit coding for visits and procedures documented by physicians, hospitals, and other providers across specialties and subspecialties
Maintain knowledge of CPT, ICD-9, ICD-10, HCPCS, HCC coding, modifiers, documentation guidelines, CMS policies, and reimbursement guidelines
Review provider documentation against reported code requirements
Formulate audit outcomes and present logical, concise summaries of correct and incorrect coding findings

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 required 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 as related to revenue management
Demonstrated knowledge of Word, Excel, and Access
Certified Professional Coder and/or Certified Risk Adjustment Coder certification awarded by American Academy of Professional Coders required within one year of hire

Benefits

Comp & perks

Full-time schedule
Day shift
40 scheduled weekly hours
No union position
EEO/AA employer M/F/Disability/Vet
Disability accommodation assistance for the online application