Title : Risk Adjustment Coding Auditor Location : Remote Job Type : Contract (5 months) Compensation : $35.00 - $38.00 per hour (W2) Industry: Health Insurance About The Role Our client is a leading healthcare organization that serves millions of members through health insurance and healthcare management programs. They are committed to improving health outcomes, ensuring regulatory compliance, and leveraging accurate clinical data to support value-based care initiatives. We are seeking an experienced Risk Adjustment Coding Auditor to support risk adjustment and clinical documentation accuracy efforts across Medicare, Medicaid, and Commercial health plan programs. This role is responsible for conducting comprehensive coding audits, identifying documentation opportunities, and ensuring compliance with applicable coding standards and regulatory requirements. The ideal candidate will bring deep expertise in HCC coding, risk adjustment methodologies, and audit best practices while serving as a trusted resource to internal stakeholders and providers.

Job Description

As a Risk Adjustment Coding Auditor, you will play a critical role in maintaining the accuracy, completeness, and integrity of coded clinical data used for risk adjustment reporting and reimbursement. This position works closely with coding, compliance, and operational teams to evaluate documentation quality, support audit initiatives, and provide guidance on coding standards.

Responsibilities

Perform retrospective and prospective chart reviews to validate risk adjustment coding accuracy. Audit diagnosis coding for compliance with CMS-HCC, Medicare, Medicaid, and ACA Commercial risk adjustment requirements. Review medical records to ensure diagnosis codes are accurately captured, supported by documentation, and reported appropriately. Evaluate coding practices for consistency, completeness, specificity, and adherence to established coding guidelines. Identify coding and documentation gaps that may impact risk scores, reporting accuracy, or reimbursement. Provide written and verbal feedback regarding coding errors, trends, and improvement opportunities. Maintain compliance with HIPAA, privacy, security, and regulatory requirements when handling protected health information. Support audit production goals and meet established deliverables and timelines. Participate in special projects, including risk mitigation reviews and targeted audit initiatives. Monitor regulatory and industry changes affecting risk adjustment coding and auditing practices. Serve as a subject matter expert on risk adjustment processes and diagnosis coding methodologies. Collaborate with internal stakeholders to improve coding accuracy and documentation quality across the organization.

Qualifications

Required Qualifications High school diploma or equivalent. Legal authorization to work in the United States. 7+ years of professional experience in healthcare coding, auditing, risk adjustment, or a related field. 5+ years of experience with HCC coding utilizing both inpatient and outpatient coding guidelines. 5+ years of experience auditing risk adjustment records. 1+ year of experience working in a production-driven environment with established quality and productivity expectations. Certified Risk Coder (CRC) credential in good standing and an active coding certification, or the ability to obtain required certification within six months of hire. Working knowledge of Medicare, Medicaid, and ACA Commercial risk adjustment models. Strong understanding of CMS-HCC methodologies, coding regulations, and documentation standards. Demonstrated ability to interpret and apply coding policies using critical thinking and analytical skills. Experience providing coding education, audit feedback, and error trend analysis. Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, Outlook, Microsoft Teams, and Microsoft 365 collaboration tools. Strong organizational skills with the ability to manage multiple priorities in a deadline-driven environment. Excellent written and verbal communication skills.

Preferred Qualifications

Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or a related field. HEDIS and/or STAR Ratings experience. Provider education or provider-facing coding consultation experience. Risk Adjustment Data Validation (RADV) experience. CPMA (Certified Professional Medical Auditor) or additional coding-related certifications. Experience supporting large-scale health plan or managed care organizations.

Benefits

Dahl Consulting is proud to offer a comprehensive benefits package to eligible employees that will allow you to choose the best coverage to meet your family’s needs. For details, please review the DAHL Benefits Summary: https://www.dahlconsulting.com/benefits-w2fta/. How To Apply Take the first step on your new career path! To submit yourself for consideration for this role, simply click the apply button and complete our mobile-friendly online application. Once we’ve reviewed your application details, a recruiter will reach out to you with next steps! Equal Opportunity Statement As an equal opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you! #BP.Indeed