Risk Adjustment Coding Auditor

Title : Risk Adjustment Coding Auditor
Location : Remote (To be eligible for this position, candidate must currently reside in one of the following states: AL, AZ, AR, CO, FL, GA, IL, IN, IA, KS, KY, MD, MI, MN, MO, MT, NV, NH, NC, ND, OK, SC, SD, TN, TX, UT, VT, VA, WI.)
Job Type : Contract
Duration: 4 months, potential for conversion to full-time employee
Compensation : $35 - $38/hr
Industry: Health Insurance

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About the Role
We are partnering with a leading health insurance organization in Minnesota to hire a Risk Adjustment Coding Auditor. Our client is a well-established health plan serving members across commercial, Medicare, and Medicaid lines of business, with a strong commitment to data integrity, regulatory compliance, and accurate reimbursement.
In this role, you will ensure the accuracy and completeness of coded clinical data that supports compliant reporting and appropriate reimbursement across risk adjustment programs. You will strengthen organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. As a subject matter expert, you will support the consistent application of coding standards and enable informed decision-making across the enterprise.
Job Description
As the Risk Adjustment Coding Auditor, your responsibilities will include:

• Evaluating risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices.
• Protecting patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements.
• Performing retrospective and prospective chart reviews to ensure accurate risk adjustment reporting.
• Verifying and ensuring the accuracy, completeness, specificity, and appropriateness of provider-reported diagnosis codes based on medical record documentation.
• Reviewing medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
• Maintaining knowledge of relevant regulatory mandates and ensuring activities comply with requirements.
• Contributing to audit and production efforts to meet business demand and workload priorities.
• Providing written and verbal guidance on coding errors to others.
• Meeting audit deliverables within established timelines and deadlines.
• Assisting with special projects, such as risk mitigation reviews.
• Serving as a subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.

Qualifications
Required Qualifications:

• 7+ years of related professional experience. All relevant experience, including work, education, transferable skills, and military experience, will be considered.
• 5+ years of HCC coding experience utilizing inpatient and outpatient coding guidelines.
• 5+ years of experience auditing risk adjustment records.
• 1+ years working in a production environment.
• CRC (Certified Risk Coder) in good standing, in addition to a required coding certification, or the ability to obtain certification within the first 6 months of hire upon possible conversion.
• Intermediate level of knowledge in risk adjustment Medicare, ACA Commercial, and Medicaid models.
• Demonstrated ability to apply critical thinking skills to coding policy interpretation and implementation.
• Experience providing written and verbal guidance on coding errors and trends.
• Intermediate (or higher) proficiency in MS Office (Word, Excel, PowerPoint, and Outlook).
• Excellent organizational ability to manage multiple projects and perform in a deadline-driven environment.
• High school diploma (or equivalent) and legal authorization to work in the U.S.

?Preferred Qualifications 

• Bachelor's degree.
• HEDIS/STARS experience.
• Provider education experience.
• Prior RADV experience.
• CPMA or other coding credentials.

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!