Medicare Risk Adjustment Compliance Auditor, CPC, CCS, CCS-P

Alignment Health

. Conduct provider- and coder-level reviews and audits to ensure accurate risk-adjustment data submission to CMS .

Posted 9/24/2026full-timeRemote • United StatesMid-LevelSenior💰 $64,384 - $96,577 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Risk Adjustment Compliance, including conducting audits, developing tracking tools, and ensuring adherence to federal and state regulations. Proficient in coding accuracy monitoring and effective communication with diverse stakeholders.

Highest-signal resume keywords

Certified Coder (CPC, CCS, CCS-P)Risk Adjustment Compliance AuditsData Validation and RADV Coding AuditsMS Office Suite ProficiencyStatistical Report Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Professional Coding ExperienceRisk Mitigation Strategic PlanningMathematical CalculationsStatistical AnalysisCoding Accuracy Monitoring

Soft Skills

Effective CommunicationLeadershipCollaborationOrganizational SkillsProblem-Solving Skills

Certifications & Qualifications

Certified Coder (CPC, CCS, CCS-P)

Industry Keywords

Risk AdjustmentCMS ComplianceHIPAA StandardsProvider AuditsInternal Reporting

About the role

Key responsibilities & impact

Conduct provider- and coder-level reviews and audits to ensure accurate risk-adjustment data submission to CMS
Develop and maintain tracking tools for Risk Adjustment Compliance
Review and audit outcomes and findings
Monitor corrective action plans resulting from review or audit findings
Monitor internal reporting for coding outliers
Review IPA policies and procedures for compliance
Monitor internal coding staff accuracy percentages
Monitor coding vendor accuracy and data quality submitted to CMS
Work with Risk Adjustment Management on data validation and RADV coding audits
Ensure compliance with applicable federal, state, and local regulations and organizational standards
Suggest customized Risk Adjustment education for support staff, providers, employees, vendors, and departments
Handle protected health information in accordance with HIPAA standards
Represent the department in RADV and other risk-adjustment audits
Maintain professional and technical knowledge through education and professional activities

Requirements

What you’ll need

Minimum 3 years of professional coding experience in a medical group or health plan setting
Bachelor’s degree in business administration, health care management or a related field, or 4 years additional experience in lieu of education
Certified Coder required — CPC, CCS, or CCS-P
Experience with strategic planning in risk mitigation
Proficient user in MS Office Suite
Ability to communicate positively, professionally and effectively; provide leadership, teach and collaborate
Effective written and oral communication skills
Ability to establish and maintain constructive relationships with diverse members, management, employees and vendors
Ability to perform mathematical calculations and calculate simple statistics correctly
Ability to prioritize multiple tasks and use advanced problem-solving and reasoning skills
Effective problem-solving, organizational and time-management skills; ability to work in a fast-paced environment
Ability to comprehend and analyze statistical reports