Risk Adjustment Auditor

Martin's Point Health Care

. Conduct coding, documentation, and validation audits of medical records and clinical data for risk adjustment vendors and other targeted universes .

Posted 10/5/2026full-timeRemote • Maine • United StatesMid-LevelSenior💰 $75,585 - $93,369 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical coding, including ICD-10 coding and risk adjustment methodologies, while ensuring compliance with relevant regulations and guidelines. Strong auditing and communication skills are essential for effective collaboration and quality assurance in medical record documentation.

Highest-signal resume keywords

Clinical Coding ExperienceICD-10 CodingCertified Coder (CPC/COC or CRC)Risk Adjustment CodingAuditing Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10 CodingICD-9 CodingCPT CodingRisk Adjustment CodingMedical TerminologyChronic Disease ManagementAuditing SkillsDocumentation AuditsValidation AuditsCoding Guidelines Compliance

Soft Skills

Excellent Written CommunicationExcellent Verbal CommunicationProblem-Solving SkillsOrganizational SkillsRelationship Building

Certifications & Qualifications

Certified Coder (CPC)Certified Coder (COC)Certified Risk Coder (CRC)

Industry Keywords

HIPAA ProtocolsMedicare Risk AdjustmentCoding Advisory CommitteeClinical DataPatient Medical Records

About the role

Key responsibilities & impact

Conduct coding, documentation, and validation audits of medical records and clinical data for risk adjustment vendors and other targeted universes
Review patient medical records, including physician notes, lab results, and diagnostic reports, to identify relevant diagnoses and capture essential information for accurate coding
Assign appropriate ICD-10 codes to document and accurately represent patient conditions and ensure compliance with coding guidelines and regulations
Stay updated with changes in HIPAA protocols, coding guidelines, regulations, and compliance standards
Meet team performance metrics for quantity of work completed and quality audit scores
Conduct RADV/IPM Chart Review duties as assigned
Periodically participate in the Coding Advisory Committee

Requirements

What you’ll need

Associate's degree or combination of relevant education and experience
5+ years of clinical coding experience
Experience in risk adjustment coding
Certified Coder (CPC/COC) or Certified Risk Coder (CRC) required
Proficient understanding of ICD-9/10-CM, CPT, and other specialty system coding guidelines
Strong knowledge of medical terminology and chronic disease management
Strong auditing skills specific to Medicare Risk Adjustment
Excellent written and verbal communication skills
Strong problem-solving skills
Strong organizational skills
Ability to relate to different types of people and build constructive and effective relationships
Ability to work independently with minimal supervision
Position is not eligible for immigration sponsorship

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
Retirement savings with employer contributions
Paid time off
Volunteer time off
Pie day
Other employee benefits
Incentive or commission-based programs may be available, where applicable