Job Details

Job Description:

We are seeking an experienced Risk Adjustment Auditor II for a remote contract opportunity. This position performs both retrospective and prospective chart reviews to ensure accurate risk adjustment reporting. The ideal candidate will possess advanced knowledge of coding, documentation requirements, and risk adjustment methodologies, and will collaborate with Provider Education Consultants to improve provider coding accuracy.

Responsibilities:

• Perform retrospective and prospective chart reviews to ensure accurate risk adjustment reporting.
• Verify the accuracy, completeness, and appropriateness of provider-reported diagnosis codes based on medical record documentation.
• Identify trends in provider coding and documentation, collaborating with Provider Education Consultants to develop intervention strategies.
• Review medical record data to ensure complete and accurate diagnosis capture for CMS HCC categories.
• Serve as a subject matter expert on the risk adjustment process and coding requirements.
• Support process and quality improvement initiatives, ensuring compliance with regulatory mandates.
• Mentor Risk Adjustment Auditor I staff and assist with risk mitigation reviews and other special projects.
• Monitor and interpret regulatory changes that impact the Risk Adjustment Program and assist with related implementation activities.

Requirements:

Associate degree in Healthcare or related field and 5–7 years of experience in clinical coding or auditing, or an equivalent combination of education and experience.

• CRC – Certified Risk Adjustment Coder (required)

• CPC – Certified Professional Coder (required)

• Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.

• Knowledge and adherence to ICD-9-CM/ICD-10 Official Coding Guidelines.

• Strong analytical, communication, and problem-solving skills.

• Proficiency in Microsoft Word, Excel, and Outlook.

• Understanding of health systems operations, reimbursement methodologies, and coding conventions for governmental and commercial products.

Pay Range:

35-37 hr

Benefits:

Our comprehensive benefits package includes:

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) retirement savings plan

Contact:

Karrie Ruch

Refer a Colleague:

Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!

Equal Opportunity Employer:

The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs.

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