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Risk Adjustment Consultant
Tufts University School of Dental MedicineRisk Adjustment Consultant performing audits and evaluations of billing and coding accuracy for Medicare and Medicaid. Working remotely to ensure compliance with coding standards and collaborating with internal teams.
Posted 4/22/2026full-timeRemote • Massachusetts • 🇺🇸 United StatesJuniorMid-Level💰 $72,371 - $90,464 per yearWebsite
About the role
Key responsibilities & impact- Performs ongoing audit of medical records for LCO groups and network providers to ensure diagnosis and CPT coding accuracy.
- Performs medical record audits to determine coding accuracy in correlation to CMS and DxCG regulations and guidelines.
- Evaluates medical records for authorized providers and other technical requirements.
- Summarizes and interprets audit findings for Director Risk Adjustment Operations/NEQCA Leadership.
Requirements
What you’ll need- Certified Risk Adjustment Coder (CRC) OR must obtain within first 12 months of employment
- Two (2) years of outpatient billing, coding, and risk adjustment experience.
- Associate’s degree highly preferred.
- Two (2) years of outpatient billing, coding, risk adjustment, and primary care adult medicine experience.
Benefits
Comp & perks- Health insurance
- Comprehensive Total Rewards package that supports health, financial security, and career growth
ATS Keywords
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Hard Skills & Tools
CPT codingdiagnosis codingmedical record auditsrisk adjustmentoutpatient billingcoding accuracyCMS regulationsDxCG guidelinesprimary care medicine
Soft Skills
interpretation of audit findingscommunication with leadership
Certifications
Certified Risk Adjustment Coder (CRC)