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Risk Adjustment Coding Auditor
TEKsystemsRemote Risk Adjustment Coding Auditor auditing healthcare compliance codes for accuracy. Supporting risk adjustment programs with expertise in HCC coding and regulatory compliance.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in risk adjustment coding and audit practices, ensuring compliance with CMS-HCC requirements and HIPAA regulations. Proficient in conducting medical record reviews and providing actionable feedback to improve coding accuracy and documentation.
Highest-signal resume keywords
HCC Coding ExperienceRisk Adjustment Audit ExperienceCertified Risk Adjustment Coder (CRC)Medicare Risk Adjustment ModelsAnalytical Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Risk Adjustment CodingMedical Record ReviewDiagnosis Coding ValidationCoding Guidelines ComplianceAudit Deliverables Completion
Soft Skills
Analytical SkillsOrganizational SkillsCritical ThinkingCommunication Skills
Tools & Technologies
Microsoft OfficeExcelWordOutlookPowerPoint
Certifications & Qualifications
Certified Risk Adjustment Coder (CRC)
Industry Keywords
CMS-HCC RequirementsHIPAA ComplianceRisk Adjustment ReportingInpatient Coding GuidelinesOutpatient Coding Guidelines
About the role
Key responsibilities & impact- Audit risk adjustment codes for accuracy, consistency, and compliance with coding guidelines and best practices
- Perform retrospective and prospective medical record reviews
- Validate diagnosis coding based on provider documentation and CMS-HCC requirements
- Identify coding and documentation gaps that impact risk adjustment reporting
- Ensure compliance with HIPAA, privacy, security, and regulatory requirements
- Provide written and verbal feedback regarding coding errors, trends, and improvement opportunities
- Support audit initiatives, production goals, and special projects
- Act as a subject matter expert on risk adjustment coding and audit practices
- Complete audit deliverables within established timelines and quality standards
Requirements
What you’ll need- 7+ years of relevant professional experience
- 5+ years of HCC coding experience utilizing inpatient and outpatient coding guidelines
- 5+ years of Risk Adjustment audit experience
- 1+ year working in a production-based environment
- CRC (Certified Risk Adjustment Coder) certification in good standing
- Working knowledge of Medicare, ACA Commercial, and Medicaid risk adjustment models
- Experience communicating coding findings and audit outcomes to stakeholders
- Intermediate proficiency with Microsoft Office (Excel, Word, Outlook, PowerPoint)
- Strong analytical, organizational, and critical thinking skills
- High School Diploma or equivalent
- Authorized to work in the United States without sponsorship.
Benefits
Comp & perks- 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)