Risk Adjustment Compliance Auditor
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Job Description
Risk Adjustment Compliance Auditor conducting audits and ensuring regulatory compliance for risk adjustment data at Alignment Health. Working remotely to support health plan initiatives.
Responsibilities:
- Conduct provider and coder-level audits, review medical record documentation and coding accuracy.
- Identify compliance risks and outliers, and support RADV and other risk adjustment audit initiatives.
- Partner closely with Risk Adjustment leadership and cross-functional teams.
- Ensure coding accuracy, regulatory compliance, audit readiness, and corrective action follow-through across the organization.
- Provide audit feedback and compliance education to internal and provider-facing stakeholders as needed.
Requirements:
- 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 in a related field or 4 years additional experience in lieu of education.
- Certified Coder required - CPC, CCS & CCS-P.
- Experience with strategic planning in risk mitigation. Previous use of Epic, Allscripts, EZCap a plus.
- Proficient user in MS office suite, MS access a plus.
Benefits:
- Health insurance
- Flexible working hours
- Professional development opportunities
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