Medicare Risk Adjustment Coding Auditor, Certified Risk Adjustment Coder

Alignment Health

. Support regular quality assurance audits of the internal Coding Analyst team to validate coding and abstracting quality and maintain a 95% HCC accuracy standard .

Posted 10/8/2026full-timeRemote • United StatesMid-LevelSenior💰 $64,384 - $96,577 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare Risk Adjustment coding, ensuring compliance with HIPAA and organizational policies while maintaining high standards of coding accuracy. Proficient in data analysis, quality assurance audits, and effective communication with clinical staff and management.

Highest-signal resume keywords

Medicare Risk Adjustment CodingCertified Coder (CCS, CCS-P, CPC, CRC)Quality Assurance AuditsData AnalysisHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medicare Risk Adjustment CodingData AnalysisQuality Assurance AuditsMathematical CalculationsStatistical Report Analysis

Soft Skills

Effective CommunicationLeadershipCollaborationProblem-SolvingTime Management

Tools & Technologies

MS Office SuiteEpicAllscriptsEZCap

Certifications & Qualifications

CCSCCS-PCPCCRC

Industry Keywords

HCC Accuracy StandardCoding AuditsData-Flow IntegrityUAT TestingRisk Adjustment Management

About the role

Key responsibilities & impact

Support regular quality assurance audits of the internal Coding Analyst team to validate coding and abstracting quality and maintain a 95% HCC accuracy standard
Track and report progress of quality assurance audits performed on coding vendors
Verify coding accuracy and quality of data submitted to Alignment Health for CMS submission
Work with Risk Adjustment Management on MRA data validation and coding audits
Review data for reconciliation, data-flow integrity, UAT testing, high-cost/low-risk-score members, retrospective chart reviews, and other risk-adjustment-related activities
Analyze and share audit results with the Manager
Support physician and clinical staff training, documentation improvement, and system/process improvement using audit results
Utilize, protect, and disclose patient PHI according to HIPAA standards
Ensure compliance with applicable regulations and organizational policies and procedures
Maintain professional and technical knowledge and stay current on coding, compliance, and HCC issues
Perform other duties as assigned

Requirements

What you’ll need

Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting
High School Diploma or GED
Completion of a Medical Coding training program
Technical School or courses required to become a certified coder
Certified Coder required: CCS, CCS-P, CPC, or CRC
Proficient user of MS Office Suite – Excel, Word, Outlook
Previous use of Epic, Allscripts, and EZCap
Effective written and oral communication skills
Ability to provide leadership, teach, and collaborate with others
Ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors
Ability to perform mathematical calculations and calculate simple statistics correctly
Advanced problem-solving and reasoning skills
Ability to prioritize multiple tasks and work in a fast-paced environment
Ability to comprehend and analyze statistical reports
Ability to comply with HIPAA and applicable federal, state, and local regulations
Ability to maintain relevant CEUs for individual coding certifications

Benefits

Comp & perks

Ample room for growth and innovation
Continuing education and professional development through educational workshops, professional publications, personal networks, and professional societies
Continuing education units (CEUs) related to coding certifications
Reasonable accommodations for individuals with disabilities
Equal employment opportunity