Risk Adjustment Coding Auditor

Job Description

Title : Risk Adjustment Coding Auditor

Location : Remote

Job Type : Contract (6 months)

Compensation : $35.00 - $38.00/hr

Industry: Health Insurance


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About the Role
Our client, a leading nonprofit healthcare organization serving members across Medicare, Medicaid, and Commercial health plans, is seeking an experienced Risk Adjustment Coding Auditor to support the accuracy, integrity, and compliance of risk adjustment reporting programs.
As a subject matter expert in risk adjustment coding, you will play a critical role in ensuring accurate diagnosis capture, validating medical record documentation, and identifying opportunities to improve coding quality and regulatory compliance. This position partners with internal stakeholders and providers to mitigate financial and compliance risk while supporting appropriate reimbursement and high-quality healthcare outcomes. Job Description
The Risk Adjustment Coding Auditor is responsible for auditing clinical documentation and diagnosis coding to ensure accurate, complete, and compliant reporting across risk adjustment programs. The role supports organizational performance through retrospective and prospective chart reviews, coding validation, provider feedback, and adherence to industry regulations and coding standards.

Key Responsibilities

• Conduct retrospective and prospective medical record reviews to validate risk adjustment diagnoses and coding accuracy.
• Audit provider-reported diagnosis codes to ensure alignment with medical record documentation and applicable coding guidelines.
• Review clinical documentation to identify missed, unsupported, or inaccurately reported diagnoses within CMS HCC and other risk adjustment models.
• Evaluate coding practices for consistency, accuracy, completeness, specificity, and compliance with regulatory requirements.
• Ensure adherence to HIPAA privacy, security, and confidentiality standards.
• Monitor and apply current Medicare, Medicaid, and Commercial risk adjustment regulations and coding guidance.
• Communicate coding audit findings and provide clear written and verbal feedback regarding coding errors, trends, and improvement opportunities.
• Serve as a subject matter expert on risk adjustment coding methodologies and diagnosis coding requirements.
• Support audit production goals and deliver work within established timelines and quality standards.
• Participate in special projects, including risk mitigation initiatives, targeted reviews, and compliance-related activities.
• Collaborate with cross-functional teams to improve documentation quality and coding performance.

Qualifications

Required

• 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 HCC coding experience utilizing both inpatient and outpatient coding guidelines.
• 5+ years of experience auditing risk adjustment medical records.
• 1+ year of experience working in a production-driven environment with established performance metrics.
• Active Certified Risk Adjustment Coder (CRC) certification in good standing, or ability to obtain certification within six months of hire.
• Working knowledge of Medicare, Medicaid, and Commercial/ACA risk adjustment models.
• Strong understanding of CMS HCC methodologies, diagnosis coding standards, and medical record documentation requirements.
• Demonstrated ability to interpret and apply coding policies, regulations, and industry guidance.
• Experience providing written and verbal education, feedback, and guidance related to coding accuracy and quality improvement.
• Intermediate proficiency with Microsoft Office applications, including Excel, Word, PowerPoint, and Outlook.
• Strong organizational, analytical, and critical-thinking skills with the ability to manage multiple priorities in a deadline-driven environment.

Preferred

• Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or a related field.
• HEDIS and/or Medicare Stars experience.
• Provider education or provider-facing training experience.
• Risk Adjustment Data Validation (RADV) audit experience.
• Additional coding or auditing credentials, such as CPMA or equivalent.
• Experience supporting coding quality, compliance, and risk adjustment initiatives within a health plan, payer, or managed care organization.

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: 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!

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Dahl Consulting is proud to offer a comprehensive benefits package to eligible contract employees that will allow you to choose the best coverage to meet your family's needs. For details, please review our Benefits Summary:


Dahl Consulting is an Equal Opportunity Employer and does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other applicable legally protected characteristics.


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