Risk Adjustment Auditor; Remote

Risk Adjustment Auditor (Remote)

Our client is seeking a highly detail-oriented and analytically driven Risk Adjustment Auditor who thrives in a regulated healthcare environment and takes pride in accuracy and accountability. This individual brings deep coding expertise, a strong understanding of risk adjustment methodologies, and the confidence to collaborate, mentor, and influence quality improvements. Success in this role requires adaptability, sound judgment, and a proactive approach to both compliance and continuous improvement.

Remote:
Candidates must work PST hours.

• Conduct retrospective and prospective medical chart reviews to support accurate risk adjustment reporting.
• Validate diagnosis coding accuracy, completeness, and specificity in alignment with documentation standards and CMS HCC requirements.
• Identify trends in provider coding and documentation and collaborate with partners to support targeted improvement strategies.
• Contribute to quality, process improvement, and risk mitigation initiatives while ensuring regulatory compliance.
• Serve as a subject matter resource, supporting special projects and mentoring less experienced auditors as needed.
• Active CRC (Certified Risk Adjustment Coder) and CPC (Certified Professional Coder) certifications (both required).
• Advanced knowledge of risk adjustment principles, diagnosis coding, and documentation standards.
• Proven experience performing detailed chart reviews with a high degree of accuracy and consistency.
• Strong analytical, problem-solving, and written/verbal communication skills.
• Proficiency with standard business software and the ability to adapt to changing priorities, including occasional evenings or weekends.

(DOE)

As an eligible contract employee with Vander Houwen, you’ll have access to a full suite of benefits designed with your well‑being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

Vander Houwen is an Equal Opportunity Employer and participates in E-Verify. Vander Houwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.