MRA Coding Auditor - Remote

Alignment Health is a remote company focused on senior care. The Medical Risk Adjustment (MRA) Coding Auditor role supports departmental quality assessment audits of internal coding analysts and vendors to ensure accurate and complete data submission to CMS. General Duties / Responsibilities Supports regular quality assurance audits of the internal Coding Analyst Team to validate and confirm coding & abstracting quality (95% HCC accuracy), ensuring coding quality and performance improvement standards are maintained. Tracks and reports progress of QA audits performed on coding vendors to verify coding accuracy and quality of data submitted to AHP for CMS submission. Works with Risk Adjustment Management on any MRA data validation or coding audit to ensure completeness and coding accuracy of all CMS submissions; this may include data reconciliation, data flow integrity, UAT testing, review of high‑cost/low‑risk score members, retrospective chart reviews, or other related data reviews as directed by the Manager. Analyzes and shares audit results with the Manager; results may be used for training physicians and clinical staff, documentation improvement, and system/process improvement. Utilizes, protects, and discloses patients’ protected health information (PHI) in accordance with HIPAA standards. Ensures compliance with all applicable federal, state, and local regulations and with institutional/organizational standards, practices, policies, and procedures. Maintains professional/technical knowledge by attending educational workshops, reviewing professional publications, networking, and participating in professional societies; stays current on industry coding, compliance, and HCC issues and maintains relevant continuing education units (CEUs). Performs any other duties as assigned to meet the organization’s needs. Job Requirements Experience Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting. Education Required: High School Diploma or GED. Completion of a Medical Coding training program. Preferred: Bachelor’s degree in Business Administration, Healthcare Management, or related field. Training Required: Technical school or courses required to become a certified coder. Specialized Skills Proficient user of MS Office suite – Excel, Word, Outlook. Experience with Epic, Allscripts, EZCap. Strong communication skills; ability to collaborate, teach, and lead with others. Mathematical skills: ability to perform calculations and simple statistics correctly. Reasoning & problem‑solving skills: prioritize tasks, advanced problem solving, define problems, collect data, establish facts, draw valid conclusions, design and implement solutions. Report analysis skills: comprehend and analyze statistical reports. Licensure Certified Coder required (CCS, CCS-P, CPC, or CRC). Work Environment & Physical Requirements The work is remote. Employees will be required to talk or hear regularly, stand, walk, sit, use hands to hold or manipulate objects, and reach with hands and arms. Employees may lift up to 10 pounds. Pay Range $64,384.00 – $96,577.00 (may vary based on location, education, experience, responsibilities). Equal Opportunity Employer Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. #J-18808-Ljbffr